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Home Health Care: A New Start for a New Year

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"And now let us welcome the new year," wrote the poet Rainer Maria Rilke. "Full of things that have never been."

For millions of older Americans who suffer from depression and chronic illness, the prospect of another year mired in isolation, anxiety and long-term discomfort can make that promise feel far too distant.

Some 60 percent to 75 percent of older Americans have multiple chronic conditions, reports the Centers for Disease Control and Prevention. And nearly 20 percent of those 65 and older suffer from depression, according to the National Alliance on Mental Illness (NAMI), with estimates ranging much higher for those who are homebound. In the grips of long-term multiple illnesses and depression, many people face a downward spiral that leads to further isolation, deeper depression, decreased activity and declining physical health.

Roberta Roberts, RN, BC, a behavioral health specialist with the Visiting Nurse Service of New York who works with people limited by age, mobility, mood and ongoing illness, has recommendations for New Year's changes that start small and can lead to lasting improvements. She offers three simple yet powerful avenues -- available to people at home and in the course of their daily lives -- to begin reversing the downward spiral.

1. Increase Social Interaction
Behavioral health nurses aim for their clients to have at least three social encounters each week. "Social health is as important as physical health," says Roberta. "It's like exercise. Your social muscles atrophy, and, by reconnecting, you build your social muscles a little at a time."

Make sure that you, or the person you are caring for, convey to loved ones how much it means to connect with Grandma (or Mom, or Great Aunt Mildred, whoever is alone in the living room day after day). If you have access, help them set up Skype or video chat, or use a speaker phone to fill the room with the voice of a loved one.

If you are caring for someone with little or no family or who is reluctant to reach out, a probing conversation might help you discover ways to build or rebuild social connections. Here are some ways to begin:

A. Find out what is standing in the way of visitors. Does the person you're caring for feel her house isn't clean enough, she doesn't have presentable clothes, she's having a run of bad hair days? Once you locate the source of the anxiety, suggest a one-step fix. Let's keep the living room clean and entertain in there... I'm sure we can find one nice outfit, and that's all you need for a visit... Let's get a hairdresser in on Tuesday and you can arrange a visit for Wednesday.

B. Acknowledge loss, in order to move on. Particularly during and right after the holidays, the death of a loved one (whether recent or years past) can add to social isolation. Help the person establish a ritual for thinking about the loved one for a certain set time each day -- in a short reflection or prayer over morning coffee, for instance -- that acknowledges the loss and helps them move on. "Otherwise, it's constantly there as a loss and a sadness," notes Roberta.

C. Address a troubled relationship standing in the way. "Everyone has a relationship that needs mending," says Roberta. Here, an attentive caregiver can make a difference, encouraging a phone call or letter (help write it) to that estranged loved one. Have the person you're caring for include happy memories and conclude with a desired action: I find it hard to leave the house, but I'd love it if you'd come by for tea. Or, Please call and let me know you are all right.

D. Connect the old-fashioned way -- by writing a letter or card. If the person has trouble writing, have them dictate thoughts to you or a home health aide. The note can include memories, questions and general well wishes. Always include a return address and phone number and a call to action.

E. Be creative when thinking of people to connect with. Maybe an 80-something widow with no living family would like to write a thank you note to the woman who delivers Meals on Wheels or the friendly receptionist at the doctor's office. Connection, after all, begins with a single step.

For more tips on connecting, see my latest blog on bridging loneliness over the holidays.

2. Tap the Power of Music
Paul Markowitz, 73, was an acclaimed jazz musician who could no longer play saxophone because of advancing Parkinson's disease. Robbed of his passion and his livelihood, he suffered from anxiety and depression, shutting himself alone in his room.

On a recent visit, Roberta found him unable to talk, eyes darting anxiously. She quickly tuned the television to a station that featured the music he had played back in the day -- Chicago jazz in the 1930s. "The transformation was immediate," she recalls. "His eyes calmed, and he started speaking again. 'I know that musician,' he'd say. 'I played with him.'"

When his wife came home, Paul (whose name we have changed to protect his privacy) talked animatedly about what he had heard. His spirited mood had a positive impact on his physical well-being, and soon he was feeling well enough to go out to a jazz concert at a local church. "He had a flight into health by hearing that music," says Roberta.

Here are some ways to tap the power of music:

• Find music channels (usually in the higher numbers) on the television, and tune in to a favorite genre or era. Write down the station and tape it to the remote, for easy access next time.
• Burn a CD or create a playlist and play it for them on the stereo, computer or mobile device
• Use headphones to intensify the experience and for those who are hearing-impaired
• Think local when it comes to concerts, such as a nearby church or high school
• Check out Concerts in Motion, which brings live performance to those who are homebound or hospitalized.

3. Practice guided imagery
Guided imagery is a healing program of directing thoughts and guiding the imagination to a more relaxed state. Imagine yourself in your favorite place on earth, the most peaceful spot you can think of...

Roberta practices guided imagery with her clients to help alleviate isolation and symptoms of depression, and take their mind off the physical pain of chronic illness. She begins by calling attention to breathing -- in and out, in and out -- and physical relaxation. Then she directs clients' minds to a relaxing place. Be specific, she advises. What do you see? Who is with you? What do you feel on your skin, in your hands? Describe the colors, the smells, the light.

Roberta suggests taping a guided imagery session that you or a visiting professional holds with the person you're caring for. Then, he or she can listen to the tape after the visit ends and recreate the relaxing interlude.

With a little more human contact, animated by healing music, and with mind and body infused by relaxing images, those who are weighed down by multiple physical conditions, depression and isolation might well welcome the new year after all -- and each day that follows.

For more information, visit the Visiting Nurse Service of New York website to learn about the VNSNY Behavioral Health program.

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