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Welcome to the Military Families Learning Network Webinar

This material is based upon work supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, and the Office of Family Policy, Children and Youth, U.S. Department of Defense under Award Numbers 2010-48869-20685 and 2012-

48755-20306.

Give Care. Take Care.

This material is based upon work supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, and the Office of Family Policy, Children and Youth, U.S. Department of Defense under Award Numbers 2010-48869-20685 and 2012-

48755-20306.

Research and evidenced-based professional development

through engaged online communities.

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Welcome to the Military Families Learning Network

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This material is based upon work supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, and the Office of Family Policy, Children and Youth, U.S. Department of Defense under Award Numbers 2010-48869-20685 and 2012-

48755-20306.

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Military Families Learning NetworkMilitary Caregiving

This material is based upon work supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, and the Office of Family Policy, Children and Youth, U.S. Department of Defense under Award Numbers 2010-48869-20685 and 2012-

48755-20306.

Available Resources

https://learn.extension.org/events/1636

The Military Caregiving Concentration team will offer 1.00 CE credit hour from NASW.

To receive CE credit please complete the evaluation and post-test found at: https://vte.co1.qualtrics.com/SE/?SID=SV_9ZRF5j2yM4biSfr

*Must pass post-test with an 80% or higher to receive certificate.

This material is based upon work supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, and the Office of Family Policy, Children and Youth, U.S. Department of Defense under Award Numbers 2010-48869-20685 and 2012-

48755-20306.

Evaluation & CE Credit Process

A Little About Me• Education

• BA, Biology• MS, Gerontology

• Experience• Extension Program Specialist III –

Gerontology & Health• PI, Military Caregiving Concentration

Area, Military Families Learning Network

• PI, Texas A&M AgriLife Extension Service, Texas Consortium of Geriatric Education Centers

Today We’ll Talk About…

• Autonomy and Decision-Making• ADLs & IADLs• Taking Care• Giving Care• Resources

• Acknowledgment• Some materials adapted/updated from Warren, J.L., et al. (1990).

Adult Sitter Clinic Program Manual. College Station: Texas A&M AgriLife Extension Service.

Autonomy and Decision-Making

• Power or right to make one’s own decisions & choose personal preferences

• Recognition of one’s values, history and personhood

• Loss of autonomy threatens well-being

Personal Decision-Making

• Personal involvement• Independence and self-esteem are promoted when the

service member is able to have a say• As abilities change…

• Ensure the service member continues to be involved in making as many decisions as possible

• Ensure the service member is able to accomplish as many tasks as possible

Substitute Decision-Making

• The Substitute Decision-Maker• The service member should select her/his substitute decision-

maker(s) if able• This includes a surrogate to assist in accomplishing tasks

• Consider• Availability to take on the role• Understanding and respect for the values and wishes of the

service member• Ability to work with others• Ability to resolve conflicts

Assessing & Recognizing Ability

• Caregivers may be unable to determine the service member's decision-making capabilities• May prematurely begin making decisions• May prematurely begin assuming roles, tasks and

functions

• Alternatively, caregivers may find it difficult to confront the service member about the loss of decision-making abilities• May choose not to take action even though they know

that the s/he is making poor decisions

Respecting & Recognizing Ability

• Caregivers may not be aware of strategies that help make it easier for service members to make many of their own decisions or performing tasks

• Caregivers• May find strategies time-consuming• May not realize how important decision-making can be

to maintaining confidence and self-esteem

Decision-Making Strategies• Some strategies to help may include

• Reducing the number of options at any one time• "Would you like to have your bath now or later?“

• Rather than "When do you want a bath?“

• Providing step-by-step guidance• "Would you like to go for a walk now?“• "Would you like to wear your blue or red sweater?”

• Listen and be sensitive to messages the service member can convey by facial expression, tone of voice and body language

The Moral of the Story

• Recognize, respect and encourage individual abilities

• Support the service member in accomplishing tasks and making decisions independently

• Involve the service member in tasks and decision-making if capable/appropriate

Framework for Decision-Making

Evaluate and Monitor

ActionService Member Caregiver

For whom?Service Member Caregiver

Is there a problem? What is it?

Description of Behavior OR Situation to be Addressed

Activities of Daily Living (ADLs)

• ADLs are basic tasks which must be accomplished to function independently• Eating• Bathing• Dressing & Undressing• Toileting• Transferring & Positioning

• Can be “scored”• Independent• Needs Help• Dependent• Does Not Do

• When unable to perform these activities, we need help from other persons or mechanical devices or both

• Persons of any age may have problems performing ADLs

Instrumental Activities of Daily Living (IADLs)

• IADLs are tasks which support independent function and support life but are not necessarily critical• Grooming and Hygiene• Walking• Grocery Shopping• Cooking• Managing Medications• Using the Phone• Food Preparation• Housework & Laundry• Driving• Managing Money

• Can be “scored”• Independent• Needs Help• Dependent• Does Not Do

Assessing ADLs & IADLs

ADLs

Function Independent Needs Help Dependent Does Not Do

Eating

Bathing

Dressing & Undressing

Toileting

Transferring & Positioning

IADLs

Grooming & Hygiene

Walking

Grocery Shopping

Cooking

Managing Medications

Using the Phone

Housework & Laundry

Driving

Managing Money

The following is provided as general information and instruction.

It should not replace or contradict the care plan or instructions that a health provider designs for the specific care needs of the service member.

Take Care: In General

• Determine ideal times of day for activities• Try to establish a routine

• Respect and maintain privacy at all times• Be prepared

• Gather all supplies, equipment, etc., before beginning a task

• Watch for agitation and frustration• A problem can’t become a problem if you avert it

• Determine key items, triggers, preferences and dislikes• Provide clear, concise, direct instructions and

communication• Practice patience and tolerance

Take Care: Be Safe• Practice good body mechanics

• Bend from the hips and knees when lifting• Use smooth, even motions – not jerky motions• Avoid twisting your body

• Know your limitations• If it’s wet, sticky and not yours…wear gloves• Wash your hands frequently

• Turn on warm water• Wet hands and wrists• Apply soap• Rub hands together for 20 seconds• Rinse hands thoroughly, keeping fingertips down• Dry hands with a paper towel• Use a new paper towel to turn off faucet

Give Care: Eating (Assisting)• Assisting with eating

provides essential nutrition and may promote socialization

• Beware of foods hot enough to burn if service member has weakness, shakiness or problems with grip

• Ensure proper hand washing for you and the service member

• Ensure appropriate assistive devices in place• Eyewear• Special utensils

• Open any packages• Provide cues

• Location of the food• How to use utensils

• Watch for appropriate intake and ask about any issues which may arise

• Don’t rush

Give Care: Eating (Feeding)

• Feeding provides essential nutrition

• Beware of foods hot enough to burn

• Do not attempt to feed if service member is not fully awake/aware

• Ensure proper hand washing and clean the service member’s face and mouth

• Don’t rush

• Provide clear, descriptive explanation of intentions and actions

• Provide clear, descriptive explanation of food items

• Bite-sized food• Make sure service

member’s mouth is empty before each subsequent bite

Give Care: Bathing (Non-Bed)• Gather supplies, wash hands and wear gloves• Assist service member to bathroom, if needed• For a bath, fill tub half way with comfortably warm

water and have service member test for comfort• For a shower, regulate temperature and flow for

comfort and safety• Assist with undressing and toileting as appropriate• Assist service member into tub or shower, facing

controls• Stay with service member and assist with bathing as

appropriate

Give Care: Bathing (Non-Bed)

• Wash using soap and rinse entire body• Work from clean to dirty areas

• Turn off shower or drain tub• Assist service member out of tub or shower• Dry thoroughly, especially creases, skin folds and

between toes• Remove gloves and wash your hands• Assist with deodorant and lotion for dry skin, avoid

between toes• Assist with dressing, if needed

Give Care: Bathing (Bed)• Gather supplies• Assist with undressing and toileting, if necessary• Remove upper bedding and cover service member with a

sheet or bath towel to maintain privacy • Assist to wash, rinse and dry face, ears and neck, encouraging

service member to do as much as able• Fold washcloth • Wet washcloth and wash eyes (no soap)

• Wipe the inner to outer part of each eye and using a separate area of the wash cloth for each stroke

• Wash and dry the face (no soap)• Wet washcloth and apply soap. Wash, rinse and dry ears & neck• Put towel under far arm. Assist service member to wash, rinse and dry the arm,

shoulder and arm pit. Repeat for near arm• Wash and soak hands directly in the wash basin

Give Care: Bathing (Bed)• Fold sheet down from the upper body and place the

bath towel over the chest• Assist to wash, rinse and dry the chest

• Clean and dry under breasts

• Assist to wash, rinse and dry the abdomen• Apply deodorant to underarms and lotion to dry skin

• Replace sheet on upper body• Remove the sheet from legs, place bath towel

underneath• Wash, rinse and dry the leg and foot. Replace the

sheet or bath blanket. Repeat for other leg• Apply lotion as needed, avoiding area between toes

Give Care: Bathing (Bed)• Replace sheet on lower body and assist to turn on her/his

side• Place towel lengthwise under service member’s back• Wash, rinse and dry the neck and back• Change bath water and start with a clean washcloth• Assist to turn onto back and assist with washing and drying

perineal area• Ensure bedding is dry and assist with dressing as necessary

Give Care: Dressing & Undressing

• Dressing helps maintain comfort, appearance, independence and self-esteem

• Encourage or assist the service member to select clothes if able • Help minimize choices by pre-selecting appropriate

clothing

• Service members with weakness or paralysis are more easily dressed in bed• Remove clothing from the strong side first• Put clothing on the weak side first

Give Care: Dressing & Undressing (Lower)• Garments that go over feet

• Put one foot at a time into legs of pants then pull up toward knees

• If service member can stand• assist to stand• pull clothing up over hips• return to sitting

• If service member cannot stand• assist to raise hips• pull clothing over hips• or turn on her/his side and pull clothing over hip on

upper side; repeat for other side

Give Care: Dressing & Undressing (Upper)

• Garments that go over arms or head • To put arms into sleeves, put your hand through the

sleeve; grasp service member's hand and guide arm into sleeve

• Garments that open in back• put one arm (weak) in sleeve then insert other arm

• Garments that open in front • put one arm (weak) in sleeve, assist to lean forward,

if able, and bring garment across the back then insert other arm

Give Care: Toileting (Urinal)• Wash your hands and put on gloves• If able to stand, assist to a standing position and adjust clothing

• Provide support while standing if needed• Give the urinal to the service member or position and hold it in place• Leave the room while the service member uses the urinal, if safe

• Give service member a hand wipe and ask them to clean hands when finished

• Tell the service member to call when finished or if help is needed• Remove gloves and wash your hands• Return promptly when called or check on her/him as appropriate• Wash hands and put on gloves prior to contact• Remove the urinal when finished and dispose• Assist the service member back to bed if standing• Clean service member as appropriate• Remove gloves and wash your hands

Give Care: Toileting (Bed Pan)• Wash your hands and put on gloves• Adjust clothing and ask service member to raise her/his or her hips, if

able• Slide the bedpan under the hips, avoiding friction and trauma• If unable to lift, turn her/his side, hold bedpan securely against buttocks

and help to roll back onto bedpan• Adjust bedpan for comfort and position• Leave the room while the service member uses the bedpan, if safe

• Place tissue in easy reach• Give service member a hand wipe and ask them to clean their hands when

finished• Remove gloves and wash your hands• Return promptly when called or check on her/him as appropriate• Wash hands and put on gloves prior to contact• Remove the bedpan when finished and dispose• Clean service member as appropriate• Remove gloves and wash your hands

Give Care: Transferring & Positioning

• Know the abilities and limitations of the service member to participate in moving

• Encourage and assist the service member to move as independently as possible

• Protect yourself and use good posture and body mechanics when lifting, positioning, etc.

• Use assistive devices as trained or as directed by instructions• Transfer belt, walker, wheelchair, etc.

Give Care: Transferring & Positioning

• Pre-position any necessary equipment as trained or directed by instructions• Wheelchair• Walker

• Ensure service member is wearing non-skid socks/footwear

• If the service member is lying down, assist her/him to a sitting position before standing

• Ensure service member’s feet are flat on the floor

• Position yourself directly in front of the service member

• Provide a count of 3 and assist the service member stand

• Pause and allow for any dizziness to subside; gain balance

Resources• The American Occupational Therapy Association

• http://www.aota.org

• The American Physical Therapy Association• http://www.moveforwardpt.com

• National Nurse Aide Registry• https://www.ncsbn.org/1746.htm

• Assistive Devices/Technology• http://www.nidcd.nih.gov/Pages/default.aspx • http://

www.nlm.nih.gov/medlineplus/assistivedevices.html • http://

www.eldercare.gov/ELDERCARE.NET/Public/Resources/Factsheets/Assistive_Technology.aspx

The Military Caregiving Concentration team will offer 1.00 CE credit hour from NASW.

To receive CE credit please complete the evaluation and post-test found at: https://vte.co1.qualtrics.com/SE/?SID=SV_9ZRF5j2yM4biSfr

*Must pass post-test with an 80% or higher to receive certificate.

This material is based upon work supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, and the Office of Family Policy, Children and Youth, U.S. Department of Defense under Award Numbers 2010-48869-20685 and 2012-

48755-20306.

Evaluation & CE Credit Process

This material is based upon work supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, and the Office of Family Policy, Children and Youth, U.S. Department of Defense under Award Numbers 2010-48869-20685 and 2012-

48755-20306.

Military CaregivingUpcoming Event…

Handling Marital Conflict Constructively

Date: October 29, 2014Time: 11:00 a.m. EasternLocation: https://learn.extension.org/events/1688

For more information on MFLN–Military Caregiving go to: http://www.extension.org/pages/60576

Military Families Learning Network

This material is based upon work supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, and the Office of Family Policy, Children and Youth, U.S. Department of Defense under Award Numbers 2010-48869-20685 and 2012-

48755-20306.

Family Development Military CaregivingPersonal Finance Network Literacy

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