Saturday, May 31, 2008

Should My Relative Move into an Assisted Living Facility?

First, what’s great about assisted living?

Assisted living is NOT nursing home care! Most people get a horrified expression on their faces when I suggest they look into assisted living for their relatives but I’ve met many other people who happily have chosen this option for themselves to retain their independence and enjoyment of living longer. Assisted living communities can be a great source of new friendships. Most of them offer activities that beat sitting by yourself in front of the television any day. Some provide transportation to things people want to do and all of them provide meal preparation, housecleaning assistance and personal care services that would otherwise be hard to manage. Assisted living frees family members from the burden of juggling caregiving with dual careers and child-rearing. It can give an overstressed spouse a chance to rest at night and can even be used, in some cases, for a week to a month of respite for those caregivers intent on mostly caring for a loved one at home.

What’s not great about assisted living?

It’s expensive. $3000-$6000/month is not unusual in this area. MediCal and Medicare do not cover assisted living and neither do many long-term care insurance policies. (Be sure to read the fine print!) However, the reality is that 24 hour in-home care is much more expensive and, when a person is willing to move, there is often a house that can then be sold to pay for services. Unfortunately, for many families the choice to use either facility care or extensive in-home services is, financially, out of the question.

Also, change, by it’s very nature, is disruptive and stressful. Moving into a new home can be especially traumatic for people who have lived in one place many years and have their whole identities wrapped up in their home environments. Dementia patients almost always go through a period of increased disorientation when they move. If they are prone to having catastrophic reactions, these displays of intense emotion are much more likely to occur in the wake of a move and caregivers who don’t expect this can be wracked with anguish and grief. Even healthy people go through incredible grief and loss at the reality of dismantling a beloved home and trying to reduce a household of belongings into what will fit in a 1-2 room apartment. New routines, diminished expectations, and being surrounded by a sea of unfamiliar wrinkled faces can bring thoughts and fears about one’s own age and mortality into sharper focus. If part of one’s belief system includes a fear of dying alone among strangers, it can feel as if one’s worst nightmares have come true.

None of these are reasons not to choose assisted living and not all people have reactions even close to this. The earlier in the course of the disease such a choice is made, the better in terms of ease of adjustment. In fact, many of my clients have been pleasantly surprised by how well their loved one adjusted to their new homes and how easily they made new friends. Some people positively thrive and come back to life. Still, it is foolish to ignore the downside. I hear just as many stories about people who gave up on living as soon as they left home and died.

So how is an exhausted caregiver supposed to make such a difficult decision?

You need to address the worries and needs of the care receiver as much as possible while doing what has to be done for your own physical health and mental well-being. Nobody benefits when a caregiver dies or goes into physical decline as a result of trying to do too much. Then there are two patients instead of one and the care receiver almost always winds up in a facility anyway—only instead of having the support their dearest loved one would have provided, they have none.

If using an assisted living facility is something the family is willing to consider, start visiting them early. Educate yourself on who provides the services and environment you prefer in a price range you can consider. Make peace with not leaving your children an inheritance or, if it’s not too late, get a long term care insurance policy that covers assisted living care.

Choose to focus on the positives when you introduce the concept of assisted living to your relative and the rest of the family. Bring the care receiver for a visit during lunch or at a time when an activity they might enjoy is planned. If you have friends or family who deliberately chose this arrangement for their retirement take advantage of their help and positive mental attitude by visiting or talking with them by phone. Alternatively, ask the facility if they have any happy residents who might be willing to chat with you. Find out why they like it and how they made their decision. Knowing others who are having a positive experience goes a long way towards dispelling many of the fears you and your family members may be carrying.

Also, understand that using facility care does not mean giving up on providing your own loving care. Reject the stereotype of the heartless relative who dumps their patient in a rest home and forgets about them. Families can still maintain a loving connection even when a demented loved one lives in a separate place. I know caregivers who pick up their patients every day to go for a drive, go out for ice cream, take in a movie or go for a walk and report that their relationships are sweeter because they can focus on love and creating pleasant experiences instead of on how to survive the stress of not getting enough sleep and providing constant supervision. The care facility provides the much needed hands-on care and respite so the caregiver is free to be a daughter, son, spouse or friend again.

Thursday, May 29, 2008

Mindfulness Meditation for Family Caregiving

Pamela Larsen Schroeder has a nice blog article about the practice of mindfulness (Vipasana) meditation as a tool for stress reduction for family caregivers. Bob Stahl, the person who co-led the Early Stage Alzheimer's Patient and Caregiver Group with me taught several of us this technique one day. I highly recommend it.

Wednesday, May 28, 2008

Should I Move My Parents In With Me?

The following blog is an excerpt from my book The Spiritual Journey of Family Caregiving available directly from me for $14.95 plus shipping.

I wish more people would ask me this question before going ahead and doing it. It can be a great solution IF the caregiver is prepared for what it will really mean. Too often, though, people have an overly romantic notion about how great it will be for their children to have their grandparents nearby and how wonderful it will be to have a closer relationship with mom and dad. They look forward to the move only to find out that dementia has changed grandpa into a mean-spirited person who spouts obscenities and grandma is so used to having her way in her own home that she is not prepared for the shift in role being a member of a combined household can mean.

Even in the very best of situations it is not simple to lose your autonomy after years of being independent. It’s hard for parents to be the rulers of their own roost and suddenly have to learn to negotiate and compromise. It’s devastating to have to lose a lifetime of belongings and the precious memories each of those possessions holds to move into a smaller space. Even young healthy people find it challenging to make the shifts and changes a new living arrangement tends to entail, especially when it involves multiple people and long-standing family dynamics. For elders, it’s doubly so.

People who have lived all their lives in multiple family households do the best... but I rarely meet those people because large extended family units who band together to share the work don’t tend to need my assistance so much. It can also work well if a family has a private apartment on the same property so their parents have their own domain and the caregiver’s family maintains its privacy and daily routines. When people choose to share a more limited space, communication about beliefs and expectations needs to be particularly clear, and there needs to be patience with the shifts and changes and negotiation living together often entails. It can be very rewarding. Mutual exchange between the generations really CAN be one of the best things you could do. But it’s equally important to plan ahead for the challenges and pitfalls. Ask yourself the following questions:

  1. Can you and your parent speak honestly and openly? Do you communicate well enough to work out differences of opinion?
  2. Do you and your parent have unresolved conflicts between you?
  3. Is there enough room in your house for everyone to have sufficient privacy?
  4. Is your home able to be adapted for someone who may have disabilities or whose mobility might be impaired? Are there specific needs that may require remodeling? Can you afford to do it?
  5. Have you determined how much care your parent will need? Can you realistically provide that much care?
  6. What will happen if more care is needed? Have you talked about long-term arrangements?
  7. How do all members of the family feel about this decision? Is anyone going to be resentful or unhappy? Are you prepared to deal with that?
  8. Are you ready to state the rules of your household and set limits on what you will or will not do? Will your parent be able to accept these expectations and limitations?
  9. How do you really feel about sharing your household? Will you be able to give up some of your autonomy in order to allow your parents to have some say in decision-making and household responsibilities? Have you created strategies to address these concerns, if any?
  10. Will you be able to find other living arrangements for your parent if the situation is no longer working?
  11. What will be great about living together? Will the advantages outweigh the disadvantages?

These questions represent only the tip of the iceberg. The Family Caregiving Alliance has a well-written and very thorough fact sheet on their website called “Home Away from Home: Relocating Your Parents.” If this is your issue it’s well worth a read!

Wednesday, May 21, 2008

Should I Move in with Grandma?

This blog post is excerpted from my book The Spiritual Journey of Family Caregiving. Buy it directly from me for $14.95.

I’ve had a number of young people in their 20’s or early 30’s decide to take on the caregiving of a beloved grandparent while staying in the grandparent’s house. Because the cost of housing is so high in the Santa Cruz area many people think doing caregiving in exchange for housing is a good deal. Grandma gets in-home care for free, the rest of the family doesn’t have to worry about her, and the grandchild has a place to live for free while figuring out what they’re going to do next. Everyone wins, right? Not so fast! The typical scenario goes like this:

Grandma has been living at home without supervision for a long time but then does something that scares the family often enough that they decide she needs more help. They offer this great arrangement to a granddaughter who is currently unemployed, just got divorced or never married and has no children. She’s the one person in the family with the fewest responsibilities and the greatest need, and she loves grandma, so she says yes. Nobody including the granddaughter thinks that grandma needs more than a few hours of assistance a day because, after all, she’s been living alone up until now. It looks like a pretty easy assignment.

So granddaughter moves in and the first thing she sees is that it takes grandma three hours to take a shower, get dressed and have breakfast (if she does any of these things at all.) Nobody has been around to see this and grandma always said she was fine and didn’t need any help. She was always dressed by the time the family saw her and she still had her social skills except for the obvious memory lapses so it appeared everything was going okay. But now granddaughter sees how hard things are for her and thinks, “Oh my goodness, this is terrible. I can’t let her struggle like this!” So she does the compassionate thing and helps grandma shower, get dressed and undressed and makes all her meals in addition to whatever else the family assumed she’d be doing.

Then granddaughter finds grandma’s handbag in the dishwasher when she’s cleaning up one day. She sees that grandma cannot remember the sequence of events needed to make a peanut butter sandwich. She sees that grandma doesn’t remember how the microwave works and leaves the heat turned up on the stove all day or the water running. Not only that, grandma starts demanding more and more attention—some of it she needs, some she just expects, sometimes it’s once or twice in the middle of the night. Sometimes she doesn’t know who the caregiver is and yells at her for invading her home or accuses her of stealing items she continually misplaces. Granddaughter was only supposed to do some light housecleaning, make sure medication was taken correctly, make the evening meal and be available if grandma needed her at night. She was going to take community college classes or get some job training but now she’s afraid to leave grandma alone during the day. Can someone who acts like this be trusted alone by herself? Could she even remember to dial 911 in an emergency? In almost no time at all the caregiver is a prisoner in the home, she has no time to do what she needs to do about her own life, she starts asking for help, and the family doesn’t understand why.

Then I hear the following complaints: “What’s her problem?!! She has free room and board! I have to work hard to put food on the table for my family and all she has to do is sit around and give grandma her meals and medication. Grandma was getting dressed by herself before! She must be making her dependent. And, personally, I think she’s just trying to take advantage of all of us. Grandma says she’s been stealing from her! Can you imagine that? The nerve of her! She just wants a free ride!” This is not a win-win situation.

Before arrangements like this are made the family needs to know a few facts.

First, everyone needs education on the typical course of the illness Grandma is diagnosed with. Read The 36-Hour Day or some other comprehensive dementia-care classic. Even those who don’t plan to do any hands-on care should know what kinds of things the hands-on caregiver is likely to encounter so they know what to expect.

Second, it’s important to be aware of the value of the services a live-in caregiver provides. One home care agency we work with (in Santa Cruz) charges $265 a day for a 24-hr live-in assistant. The same agency charges $18/hr for shorter lengths of time. Other homecare agencies charge a lot more. If you advertise through the newspaper you might find an independent home-care worker who will charge $12-15/hr but no matter how you do the math, daily live-in help is worth a lot!

But getting free room and board is worth a lot, too, you say? Again, let’s do the math! A typical studio apartment or small one-bedroom in the city of Santa Cruz rents for between $850-1200 a month. Shared housing (two or more people sharing a multi-bedroom house) runs between $550-800 per bedroom (although a few “bargains” exist in converted storage sheds or by choosing to live in a more remote or run-down location.) If the caregiver has a private bedroom, all utilities paid, and access to the entire house and yard, in Santa Cruz that work exchange could be worth about $750/month or more. At $15/hr, $750 will buy you 50 hours/month of homecare services or 12 hours/week. In lower rent districts, the number of work exchange hours would be even less. But this is family, you say? OK, but even if the service is valued at the minimum wage of $6.75, that’s 111 hours/month or less than 25 hours/week. Under any circumstance, for their basic health and well-being, the caregiver should still have a few days or evenings off.

If a family member cannot be trusted to live in their home alone anymore, it’s important to understand that, eventually, more than one person will need to be involved in their care. Live-in arrangements need to include regular time off and, if the time required for caregiving prevents the caregiver from having a normal part-time job, adequate compensation in addition to room and board should be provided to give the caregiver an income and a reasonable standard of living.

Sunday, May 18, 2008

Making Choices About Living Arrangements for Dementia Patients

The following post is an excerpt from my book The Spiritual Journey of Family Caregiving available directly from me, autographed, for $14.95 plus shipping.

To Move or Not to Move

I moved this past month and coincidentally (or not) almost all of my new clients this month have been grappling with issues related to moving. Should I move my mom in with me? Should I move closer to her? Should I be looking for a nursing home or an assisted living facility for my relative? How can I avoid moving my spouse? These are big questions with few simple answers. Moving is stressful even under the best of circumstances but when dementia is part of the picture some kind of change in living arrangement is almost always absolutely necessary as time goes by. This is such a big issue we’ll be looking at various aspects of it over the next few months. I hope it helps sort things out for those of you grappling with this very challenging subject.

The Choice to Keep a Loved One at Home

This is by far the most popular choice, the one most people say they want. And yet, with Alzheimer’s Disease and other progressive dementing illnesses, it is a choice that many people will say is impossible. The Number One complaint I hear from caregivers is that somebody they trusted tried to convince them to place their relative despite their wish to do otherwise. Instead of receiving help in how to keep their relative home they heard “You can’t expect to be able to do this! It’ll kill you!”

Please understand the love and concern behind such a statement. According to the Journal of the American Medical Association (JAMA), in an article printed a few years ago, dementia caregivers over the age of 60 die at a much higher rate than people who are not caregiving. And yet, a new study recently published in the New England Journal of Medicine found that a year after the death of an Alzheimer’s patient, hands-on caregivers were less depressed than those who moved their loved one to a nursing home. Even though taking care of a person with Alzheimer’s Disease is known to be harder on people than taking care of someone with cancer or many other diseases, death appears to bring closure for caregivers while institutionalization can bring guilt and loneliness. In my work with family caregivers I’ve noticed that if the caregiver has enough help to handle the stresses involved, caregiving at home brings the highest sense of satisfaction. There’s the pride and increased self-esteem that comes with the completion of any hard job and relief that the journey is over. Hands-on caregiving also gives the opportunity to heal old wounds or make amends for past behavior.

What you most need to know is that most of the time caring for someone with dementia at home CAN be done and—if you are willing to do whatever it takes—it is often the best solution for all concerned. The key, though, is being willing and able to do whatever it takes.

  • Are you willing to ask for help?
  • Are you willing to make changes in your home environment and normal routines?
  • Are you willing to accept help from wherever it comes (family, friends, neighbors, church members, and community agencies) even if you would prefer that your problems be kept in the family?
  • Are you willing and able to have care workers in your home 24 hours a day at the very end?
  • Are you willing to deal with incontinence, difficult behaviors and physical disability for as long as it takes, even 10-15 years?
  • Most importantly, are you willing to do whatever it takes to take care of yourself so you are able to be a caregiver as long as you desire?

You CAN do this work if it’s your highest heart’s desire. The first caregiver I met through the Alzheimer’s Association was a woman in her 90s who proudly cared for her husband at home until he died. I’ve met caregivers so frail I couldn’t believe they weren’t patients themselves who steadfastly stayed the course. They usually (but not always!) have a patient who is sweet and appreciative, they accept help wherever it comes from, and they know in their hearts, without any doubt, that this work is their highest calling.

Not everyone is so lucky.

Some patients are abusive, keep the family up all night, wander, or have a history of having been so difficult throughout their lives that people who could have helped stay away. If solutions are not found for these problems, home care can become a nightmare.

Some people don’t have family members who can help, refuse to ask assistance of neighbors or friends and can’t or won’t pay for services. Some people have chaotic work schedules, are raising small children, and can’t meet the needs of someone with severe and worsening dementia as time goes on without a lot of help. Some have health problems of their own and others have made choices that make long-term caregiving an impossibility. Then different solutions have to be found.

But let’s assume, for this article, that you’re going to make this choice. What needs to happen to make that successful? The following list of suggestions is the best place to begin no matter what decisions you make about caring for your relative but they are absolutely essential for anyone planning to care for a loved one at home.

1. Find out everything you can about the typical course of the illness or conditions you are grappling with. What are the most likely issues to arise? What is the worst case scenario? What agencies provide services you might need? Where can you get more information?

2. Call a family meeting. Include your patient if they are still capable of making choices and planning for the future. The purpose of the meeting is to educate people about the disease and make sure everyone is on the same page when it comes to what’s coming next. Choices will have to be made about care and who can provide it or pay for it. If your patient will need 24-hour care, eventually, the job will not be possible to do at home if it falls to one or two people alone.

People need to sleep, eat, get plenty of exercise and social contact and have ways to find enjoyment in life. A plan that does not include an adequate night’s sleep and time off for rest and recreation is not a realistic plan. How will the family divide the work or find and hire workers to supplement the work family members do? What community services is the caregiver or patient eligible for? What will your insurance plan cover? What resources do you have to pay for care (rainy day savings, a line of credit or a reverse mortgage on the house, etc.) Is there an extra room for a care worker to spend the night or can family members take turns doing night care duty? Will people need training to handle incontinence, lifting and helping the patient move from a bed to a chair, or managing difficult behaviors? There needs to be a contingency plan made for the worst case scenario.

If you don’t have all the information you need at this first meeting, split up the task of finding the information and schedule more meetings until a plan of action is in place. Expect that the plan will change because the true course of the illness is what will dictate the actions required and that can never be predicted 100% in advance. But at least you will have talked about possible scenarios and will have done the advance planning required to allow your most desired outcome a chance to come true.

3. Based on what was discussed at the family meetings, make any needed appointments with attorneys and/or financial planners. You need to know how to invest or free up money wisely and legal documents need to be written that will allow a person you designate to make necessary decisions for you and your loved one should one or both of you become incapacitated and unable to make decisions for yourself.

4. Learn to let go and share the caregiving with others before you think you “need” to. Your loved one needs to get used to receiving help from others BEFORE a crisis forces such a change to occur. Get in the habit of having time off every week for your own interests. Most people with dementia become very dependent on the person who provides them care. Don’t let that responsibility be yours alone!

5. Make taking care of your own physical and emotional health your highest priority. Forgive me if you’ve heard this before but, as on an airplane, you must put your own oxygen mask on first before attempting to help other people. Create an enjoyable routine that includes adequate rest, exercise, nutritious meals, social contact and recreational activities. If/when caregiving activities start to eat into that time a big red flag should come up for you. Never skimp on these activities except in an emergency and know that an “emergency” that lasts more than a few weeks is not an emergency—it’s time to make a change in how caregiving is done and how much help you need to have.

6. Join a support group either in person or online. You don’t have to tough it out on your own even you have no family or friends nearby. A group of people who understand what you are going through can even be a better source of support than long-time friends who don’t know how to help in exactly the way you need. In a support group you’ll make new friends, share some laughs, maybe even create a caregiving cooperative to spread the work around and lighten the load. And there’s nothing like getting input from a variety of sources for inspiring you with how human creativity can come up with solutions for just about any challenge you may encounter.

7. Keep a notebook with all the information anyone would need to provide care for your loved one inside. List all the medication he or she is taking, what they are for and how and when they need to be taken. Have emergency contacts with social security numbers, Medicare and MediCal information, health insurance numbers and anything else a person filling in for you would need to have in an emergency.

8. Call family and friends regularly and keep them informed of what’s happening. Keep them involved by sharing your concerns and help them help you by planning respite breaks or by accepting their offers to be of assistance in other ways. A home-cooked meal brought over with a loving smile can go a long way when times get rough. Say “yes” when people ask to help and insist that they let you help them.

Friday, May 16, 2008

Using Family Caregiving An Excuse

Dare I bring this up?

Is there ever a possibility that a person is doing family caregiving—excessively, that is—in order to have something to blame for not living their own life?

I had this experience several times when I was a Family Caregiving Consultant: I'd be listening with great sympathy to a caregiver complain to me about how much she or he resented the inordinate amount of work family caregiving took in their lives, how it prevented them from having what they wanted or needed, and how very very angry they were about it. We'd go through the usual intake interview, I'd explore multiple options with them for how they could get more help or make changes in their caregiving situation . . . and bit by bit I'd realize that they NEVER followed through on anything we talked about.

A counselor isn't supposed to take these things personally and heaven forbid we get mad. But not that long ago a light dawned for me: they didn't want to change anything because if they did they'd have to face the real demons in their life. Grief, disappointment, resentment, fear and pain left over from the past that held them back from doing the things they wanted in their lives anyway.

Easier to blame Mom for not accepting help or to blame the family and friends who aren't doing enough than to say "I'm sorry Mom. We have to get help, there's no choice—I'm not available as much anymore. (I'm going to school, I need a job, I'm having a baby, etc.)" Because that means...

Now I don't mean to be insensitive here. A lot of us engage in this behavior. I do it myself at times. But, seriously, is caregiving for mom or dad REALLY to blame for you not living the life you want (and I know this post does not apply to everyone!)... or is it the excuse?

Thursday, May 15, 2008

Is It Really that Hard to Find Good Paid Help?

The following blog entry is an excerpt from my book The Spiritual Journey of Family Caregiving, available for sale directly from me.

Most caregivers I meet report trouble in finding qualified paid caregivers to take care of their relatives. Nursing homes and in-home support agencies report similar difficulties. In fact, we appear to be in the midst of an insurmountable crisis in caregiver support in this city... but is this really the whole picture?

Most of my clients do not need skilled nursing care for their relative. They just need respite, someone to be with their relative and keep them safe while they take a break or go to the grocery store. They need someone with the ability to follow directions, make a lunch, wash some dishes, take the patient for a walk, or sit and read a book while the patient takes a nap. Everybody wants an experienced person with credentials but what most people need most is a “patient-sitter.”

One of my clients has had no trouble finding the help she needs. She hires college students to take her mom to her physical therapy appointments, do some light housework, run errands, or simply sit and do schoolwork in the living room so her mom will not be alone when she needs help getting up from a chair or going to the bathroom. She can leave her mother for long periods and gets all the respite she needs, knowing that in an emergency someone with the ability to call for help will be there. Her college students know nothing about dementia but they learn quickly. She borrows books and videos from the Alzheimer’s Association to teach them what they have to know. It’s not perfect—some people don’t work out—and she’s lucky that her mother is not combative and seems to enjoy the company. She’s also not able to depend on only one person for all the times she needs help—she’s had to hire several who are available for different days and times. It’s a lot more work than simply hiring an agency; but the payoff has been terrific.

The going rate for hiring a “patient-sitter” (in Santa Cruz, CA in the year 2001) is $8-12/hour, depending on experience. Is it worth it? Well... was it worth it to hire a teenager with even less life experience to babysit when you wanted a night out then? If you are willing to take the time to provide training it will be safe enough and well worth the effort.

For those able and willing to take advantage of it, there’s a large relatively untapped market for caregiver support:

College Students. To hire a college student from a local college or university, call the school’s Student Employment Office.

Mature Women. Women attempting to re-enter the workplace after raising their families often make good caregivers. Contact the local YWCAs, college Women’s Centers, and state and local employment agencies and temp agencies such as Manpower or Kelly Services.

Church Members. Put a flyer on the bulletin board or post a notice in the church bulletin.

Retired Persons. Post a flyer in mobile home parks, retirement communities, senior centers, or libraries.

Tuesday, May 13, 2008

Healing Through the Human Energy Field

The following blog is an excerpt from The Spiritual Journey of Family Caregiving.

In the July/August 1998 edition of the American Journal of Alzheimer’s Disease a very interesting article was published on the use of a new approach for increasing the quality of life for both patients and caregivers. The article described in great detail the results of a study conducted at the Alzheimer’s Resource Center of Connecticut in 1996 and 97. Using this approach, staff at this 120 bed skilled nursing facility discovered that a profound state of relaxation could be induced in a patient within 5-10 minutes without the use of drugs or any invasive techniques. Even fairly agitated patients who were rocking or calling out from their beds could be calmed in a reliable and rapid way. Fewer medications needed to be used, and positive feelings between patients, staff and family members increased. What was this new treatment? An old one—”laying on of hands”—in a new guise called Therapeutic Touch.

It may seem unbelievable or like religious hocus pocus but evidence is mounting that ancient healing arts which focus on the human energy field like acupuncture, chi gung, tai chi and energy healing, have positive and demonstrable benefit. I’ll be focusing on two forms of energy healing in this article that appear to have particular benefits for dementia patients and their caregivers, Reiki and Therapeutic Touch.

Therapeutic Touch

In Therapeutic Touch the practitioner does not actually touch the patient. The practitioner holds their hands a few inches away from the patient’s body and consciously directs a flow of energy into and around the patient while in a calm meditative state. Sometimes, visualization is used by both the patient and practitioner to intensify the focus of healing but that is not necessary. A patient does not have to be cognitively aware of what Therapeutic Touch can do for it to be effective. In fact, some of the most successful treatments have been performed on babies and people in comas. This makes it particularly useful for dementia patients, especially those who don’t like to be touched.

Therapeutic Touch was developed by Delores Krieger, a professor of nursing with a special interest in neurophysiology. She documented her research on the use of this method so well that Therapeutic Touch classes have been added to the nursing curriculums of 80 colleges and universities in the United States and abroad including major university medical centers such as Columbia-Presbyterian Medical Center in New York. Therapeutic Touch has been used to reduce pain, accelerate healing, relieve anxiety, and help terminally ill people face death. The Connecticut study mentioned above, however, was the first extensive study on the use of this approach with Alzheimer patients.

Therapeutic Touch is based on the idea that there is a universal life energy that supports all living things and through which all matter and consciousness are interconnected. This core belief is the foundation of most eastern therapeutic systems. This energy is known as “chi” in China, “ki” in Japan, and “prana” in India. Practices such as yoga, pranayama, chi gung, and tai chi as well as therapeutic approaches such acupuncture and acupressure all work with the theory that illness is caused by an imbalance or disruption of this energy flow and that balancing life-energy flow throughout the body is the key to good health and long life. The practitioner of Therapeutic Touch learns to sense energy imbalances in the energy field that surrounds a person’s body and uses stroking motions and visualization to smooth the energy out. It takes practice to learn and an intensive training program.


Reiki is a form of energy healing from Japan with roots that some people say stem from ancient Tibet. While it has been practiced for far longer than Therapeutic Touch, Western research on its effectiveness has only just begun. Preliminary studies, however, have produced similar results.

Reiki is interesting to me professionally because it is extremely easy to learn and easier to do than Therapeutic Touch. It is also easier to use on oneself than Therapeutic Touch so it can be taught as an effective tool for self-care. The practitioner’s hands are placed gently on the body or an inch or two away. There are twelve basic hand positions that are done in sequence which cover all major areas of the body. Practitioners do not need to feel the energy imbalances for Reiki to work; they simply hold each position for a specific period of time. The practice does not require a meditative state or extensive visualization. In fact, it can even be used by a caregiver in a highly stressed state of mind. I learned Reiki five years ago and use it most often for self-care on those days when my emotions need soothing. It has a comforting quality that never fails to leave me more relaxed, centered and calm.

What makes Reiki unusual from a Western perspective is that the practice is passed on through an ancient healing ritual in which the participant is spiritually attuned to the power of the practice. My intellectual mind couldn’t make sense of this but I found it an interesting cultural experience that added to my enjoyment of the class. Even though Reiki is considered spiritual in origin it is not part of any particular religion and does not require one to adopt new religious practices or beliefs. However, for those who grew up without spiritual beliefs or for those that were taught that only Christ could (or should) heal, this practice would challenge some very basic long held beliefs.

I use Reiki to release tension on those nights when I can’t sleep. It has been effective in my life for headaches, minor aches and pains and other stress-related symptoms. Reiki practitioners report that it can decrease the need for medical intervention, decrease or eliminate side effects with medicines, reduce a patient’s recovery time from an invasive procedure, or strengthen a patient’s immune system. Two hospitals in the community where I live have arranged to have Reiki practitioners work with both patients and staff.

Follow-up Commentary:
Not long after I wrote the above article I convinced my agency to let me offer an introductory Reiki workshop for family caregivers. It was a great success! Only 5 people participated, ranging in age from 45 to 90, but they all succeeded in learning the techniques and three of them reported later that they were using Reiki with themselves and their patients (the other two didn’t report back except to say that they really enjoyed the experience of learning it). One even calmed her husband in the middle of the night during a highly agitated period when he was terrified and threatening to hurt her. She used the hand positions recommended in the class and in less than 10 minutes he let out a sigh of relief and settled back down.