December 2021 OutreachNC by OutreachNC

DECEMBER 2021 - 1

D E C E M B E R 2 0 2 1

Feature Intro: COVID and Caregivers The COVID-19 pandemic has affected all of our lives. The pandemic impacts big-picture issues such as education, taxes and healthcare mandates. It also affects daily life from issues as small as the availability of toilet paper to delays in furniture shipments and accessibility of medication. All of us are impacted. Some people, however, feel the effects of COVID in unique ways. Frontline healthcare workers and caregivers are among those for whom COVID has affected daily life. Healthcare workers and caregivers don’t only include professionals. Family caregivers are also affected by the pandemic, and the challenges of caregiving have only heightened in the past two years. For many family caregivers, the COVID pandemic has made the job of caretaking more stressful, adding to an already hefty burden. In learning how to adjust to our new normal (postpandemic), all of our lives will change. For caregivers, we offer insight into how these changes may affect the experience of caregiving and tips for how to transition from pre-COVID to (hopefully one day) post-COVID as that transition relates to caregiving.

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CONTENTS

ASK THE EXPERT: AGING WITH INTENTION FEATURE: COVID AND CAREGIVERS FAITH: PATIENCE EYE HEALTH: FLOATERS AND FLASHES RECIPE: SPICED CIDER

LETTER FROM THE EDITOR

Amy Phariss, Editor-in-Chief, OutreachNC | editor@outreachnc.com

DECEMBER 2021 - 2 As I sit by the window contemplating this issue of OutreachNC, I am struck by how much of the conversation remains about COVID. Two years ago, we were blissfully preparing for the holidays without a hint of “pandemic” or “virus” swirling in our heads. Now, these phrases are commonplace in our conversations. A year ago, I thought in another 12 months, the conversation would have dwindled to past tense. Here we are, the 12 months upon us, and we are still talking in the present tense. As we prepare for another holiday season and new year, we do so in slightly different ways. We are more careful, perhaps, with our health and hand washing. We consider travel in a different way. We consider staying home more than we might have thought pre-COVID. The ways in which we interact in almost all areas of our lives have been, in the least, touched. It is a new normal. This month, we explore how caregiving has been affected by the pandemic. Aging Outreach Services’ Lead Care Manager Jennifer Tyner provides insight into how caregivers have been impacted and the unique ways in which COVID has changed caregiving relationships. In Ask the Expert, Kate Pomplun offers tips and advice for making decisions regarding aging at home or moving to an assisted living facility. Pomplun’s advice helps families navigate a possibly challenging conversation.

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Dr. Kendall Wannamaker, of Carolina Eye Associates, explains what eye flashes and floaters are and when calling a doctor might be necessary. Finally, Colette Bachand ends the year with a Christmas wish we can all relate to – a plea for patience. Even in our new normal, there is much to celebrate. There are friends and loved ones awaiting a warm cup of cider (see recipe on page 15), ready to regale us with stories and anecdotes at this year’s holiday dinner. There are errands to run, gifts to purchase and prayers to pray. There are those less fortunate in need and those with extra ready to provide. We are, after all, still here together, and our unity and community couldn’t be more necessary than it is now. Happy holidays,

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ASK THE EXPERT: AGING WITH INTENTION

DECEMBER 2021 - 4 My great-aunt has expressed her desire to age in her home rather than transfer to an assisted living facility. We, as her family, want to honor her wishes. However, my great-aunt has a few chronic health conditions including diabetes. We want to be sure she can manage her health or have the help she needs. How can we help her stay at home while receiving the care she needs? Your question is an important, common and relevant question many families face today. We want to honor the wishes of a loved one while also ensuring their safety and wellbeing. It’s not an easy conversation, but a few suggestions may be helpful as your family navigates this important decision. First, it’s important that your great-aunt be heard and listened to thoughtfully and with empathy. This isn’t a conversation to have with her after you’ve made a decision. This is a conversation for everyone to have together, with your aunt’s desires front and center. The fact that you want

to honor her wishes is a great sign that you are, indeed, hearing her needs, wants and concerns, which helps empower your aunt and is the first step in making a collective decision. Second, have a conversation with your aunt about her health conditions. This can be a challenging conversation for many older adults who are private about health issues or don’t want to burden others with their care. However, talking openly about the condition, the long-term needs and how these needs can be met is a step toward creating solutions and understanding how to meet your aunt’s wishes and needs. Talking through how she will get to and from appointments, how she will get her medication and how she will track her health are all important points to consider and discuss. Be sure to inform yourself about her health conditions so you all can talk from an educated, informed position. Speak with a doctor or health care professional about diabetes, for example,

DECEMBER 2021 - 5 before broaching the subject with your aunt. It will go a long way to show her you care, you’re informed, and you are knowledgeable about how to help her make the best decision possible. Third, speak with local care agencies, healthcare providers and support systems in place to help people wishing to age at home. Pharmacists, doctors, care managers and counselors can all offer advice for helping your aunt think through this decision. When you know what is possible for your aunt at home, you can help her decide which living situation will best meet her needs.

Touring or visiting a care facility may also be helpful, allowing your aunt to ask questions and explore a facility before she might want to make a move. With the proper information and insight, you can help your great-aunt flesh out the details of meeting her healthcare needs while also

continuing to live at home, if that’s the best option. Having a professional perspective helps take the guess work out of the equation and makes the conversation much more productive and realistic. Each of these conversations will help your aunt identify her needs and make the best decision for her health and safety. Through talking, listening and exploring, your aunt’s wishes can be fully understood and honored, and you can learn more about how to best help her manage her health while remaining where she is most comfortable for as long as possible. While these conversations aren’t easy, they’re worth the time and investment for everyone’s comfort and happiness. Whatever you decide, and whichever living situation is best for your aunt, you will know your decision was well-informed, thoughtful and intentional.

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DECEMBER 2021 - 6

COVID & Caregivers by Amy Phariss

DECEMBER 2021 - 7 Jennifer Tyner serves as Aging Outreach Services’ Lead Care Manager. With over two decades experience in care management, Tyner is an Advanced Care Planning Consultant, is trained in Alzheimer’s education and is a Professional Member of the Aging Lifecare™ Association. Tyner sees firsthand the challenges, rewards and commitment of caregiving, working daily with families who provide care for loved ones without any financial compensation. Tyner sat down with ONC to talk about her experience with caretaking and care management since the pandemic hit and offer insight and advice for those who are working in these roles. This interview has been edited for length. OutreachNC: According to a recent study by the National Rehabilitation Research and Training Center at the University of Pittsburg, 63% of family caregivers surveyed report increased caregiving efforts or duties since the onset of the pandemic. Can you describe what this might look like for a family caregiver? JT: I feel like it’s less in some ways. Truthfully, a lot of people have taken family members out of facilities because of lockdown or quarantine. People who could bring their loved ones home, did. Also, options like adult daycares shut down. There have been changes in every structure. So, the caregiver’s work hours have changed with a loved one at home. Some people lost their job, so they couldn’t afford someone to take care of their loved one, so they’re doing all the care themselves. So, then, it makes it hard for them to get a job when the time comes for that. ONC: The study also reports that 21% of family caregivers say the pandemic has interrupted or affect the caregiver’s own healthcare. Can you speak to how this happens? JT: This definitely happens. An increase of caregiving increases stress. We see all the time how the stress affects a caregiver in a negative way. Even support groups moved to Zoom, if at all. This was such a good time for them to be with other people who are experiencing what they’re experiencing. This shut down for many people, and the stress adds up. Also, caregivers might push their own healthcare to the side to care for a parent or loved one. There are only so many hours in a day for appointments.

Also, people were just avoiding healthcare offices in general. I had a hard time convincing my own parents to keep their own doctor’s appointments. They didn’t want to be around people who weren’t well. They didn’t want to get sick. ONC: Many caregivers report increased mental health issues since the pandemic including increased anxiety and/or depression. What factors might contribute to this? JT: Loneliness is an issue. A lot of people in facilities couldn’t leave their rooms for close to a year. Almost all social activities were shut down for that time. The same is true for caregivers and loved ones. Socializing was shut down for everyone. A lot of the fun, enjoyable things were taken away. They didn’t do the book club, the quilt club. Restaurants were shut down. So, there was less support all around. Caregivers didn’t have that outlet to get away anymore, to recharge their batteries. Also, when facilities are on lockdown, and you can’t see your mom, it’s really hard. You can’t see your mom. You feel responsible for her happiness, for her life. It’s really hard for people. It’s emotional. And people don’t know when another lockdown will happen. ONC: Many caregivers are working longer hours and taking on more responsibility during the pandemic. We know social isolation is challenging for the aging population, but how is isolation affecting caregivers themselves? JT: I’ve seen caregivers burning out faster, professionally and personally. Even paid caregivers are burning out faster because of the stress of leaving their own families and putting themselves at risk of being exposed to the virus. There is just an increased level of stress. People during the pandemic aren’t comfortable caring for people. ONC: What support is available for caregivers who might feel overwhelmed with their roles or who may need help themselves? JT: Care managers and online support groups are both great resources. A few support groups have started back in person. I always encourage caregivers to educate themselves.

DECEMBER 2021 - 8

That always alleviates stress, knowing what is normal or abnormal and knowing what to expect from someone you’re caring for. A lot of caregivers are caring for someone with dementia, which is really hard for caregivers. Having education and knowledge about what to expect from your loved one and also of yourself is key. You need to know your limits. ONC: What are some common mistakes you see caregivers make, often unknowingly, that make caregiving harder, especially during challenging times? JT: Not knowing their limits, not knowing what their breaking point is. I always tell clients and mention in support groups: everybody has a breaking point. We have to acknowledge this. Whether it’s related to toileting or certain behaviors or a number of hours you’re working. If you don’t know your breaking point, you run the risk of hurting a loved one and hurting yourself.

And again, you have to know their issue or disease, and you have to know what to expect. Knowing everything you can about a disease or condition is really key to managing expectations. Also, not taking advantage of resources is another mistake. Even with dementia, there are grants to provide care management for a few hours to make sure the house is set up the way it should be. The MS society has the same thing for MS. Every disease would have something like that, some kind of funds to help you get what you need. ONC: What advice do you give caregivers who may be feeling anxious or depressed but who do not recognize the need to care for their own mental health? JT: If you don’t take of yourself, you can’t take care of your loved one. It’s a viscous cycle of care. You have to always keep in mind that if you’re not well, you can’t care for the person you’re supposed to be caring for.

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It’s not selfish to take care of your own needs. This is what I mean by looking past that – the idea you’re being selfish. Look at it like you’re being selfless. ONC: We are coming up on some major holidays for many, which often includes travel, more social engagement or visits with family and friends. Do you have any advice for caregivers to manage what can be a joyous but also stressful season? JT: Take the breaks you need. Continue with your traditions. Educate yourself on what’s the best way for your loved one to be with you – whether you have to shift the house around a little or hire a care manager for a few days. Get the support you need to keep your traditions going, which is important for you. ONC: The pandemic has meant learning new technology for many people. What ways have you seen technology help caregivers manage their responsibilities? Have you seen any technology that is particularly useful? JT: I’d say support groups being offered online is big. Also, telehealth is big. There are many platforms for telehealth therapy online. It’s important to take advantage of these things. A lot of insurance will cover therapy, so be sure you’re aware of what’s available.

ONC: Finally, Jennifer, we’d like to ask how we can support our caregivers and help lessen their burden. What can family members who aren’t serving as caregivers do for those family members who are caregivers? How can we help? JT: I love the concept of a care team. So, you know, just putting together meals, putting together time coverage. You can sit with someone so the caregiver can go to the grocery store or take a nap. Caregivers need time for themselves, so if there isn’t something specific a loved one needs (like medication or bathing), another family member can help out and sit in. This can make a big difference for the caregiver who is the primary caregiver. As a family member, you can remind caregivers to take care of themselves. Remind the caregiver that we need them healthy and happy, too. And send cards, gift cards, messages, texts – let the caregivers know you appreciate their work and are thankful for what they’re doing. This really goes a long way. We can all be part of that team.

The Rev. Colette Bachand | cwood@penickvillage1964.org

FAITH: PATIENCE

DECEMBER 2021 - 10 All I want for Christmas … is a little bit of patience! Of late, it’s been hard to come by. On hold times seem longer when calling anywhere to get information. Waits for a table at favorite restaurants are longer due to staff shortages, say nothing of trying to get an appointment with a medical specialist, whose office is also short staffed. Airline flights are canceled. And if you haven’t seen the checkout lines at Walmart lately with just two cashiers most days, well, let’s just say deciding maybe you didn’t need those groceries after all becomes very tempting. Supply chain shortages, staff shortages, no used cars to buy, and waits for parts should your dishwasher break down … these are real struggles as the world adjusts to living, still, with the COVID pandemic, which by the way, just saying “pandemic” makes me impatient.

I’m tired of every other conversation beginning with, “Because of COVID …” Which is why patience is on the top of my Christmas wish list, for myself and for my fellow human beings. We really do have to be more patient with each other, despite how tempting it is to complain to the waitress about the long wait for that bacon burger with fries, or yell at the guy on the phone who tells you the new chairs you ordered won’t be in on time for Christmas … likely stuck in a container ship off the California coast. If you’ve wanted to yell “UGH” at something lately, you’re not alone. We’ve become very accustomed to getting things and services right away; we are not used to waiting. Yet in these weeks before Christmas, it is the season Christianity calls Advent, a time in fact, of waiting, waiting for the advent of something new, new light, new life, new hope. It is a season of trusting that there is grace and benefit in waiting for something, so we must be patient. Perhaps one of the best places to start practicing patience is with ourselves. Sometimes… no,

usually… we are harder on ourselves than other people. Perhaps you are being hard on yourself this season, critical and impatient with yourself because things don’t feel the way they should, for one reason or another. And frankly, one reason may begin with those words, “Because of COVID…” as much as we wish we could stop saying that. Older adults I journey with share that this holiday season is tricky. They want it to feel like everything is back to normal. It’s been a full two years since we engaged in our usual holiday traditions, and last year was perhaps the loneliest holiday seasons on record. While we are grateful to be together this year with family and friends, it’s not easy to jump back into our old lives. Many have said they struggle with decisions about how much to travel, what events to go to, who to gather with. Two years is a long time and can make a difference in what feels manageable, fun or meaningful. None of us are who we were Christmas of 2019. Which is why having patience with ourselves may be the best gift we give this season. If things aren’t feeling quite right know that, not only are you not alone, but we’re all still adjusting and going slow is ok. Creating boundaries for what does and doesn’t feel right is ok; honoring your time, space and energy is appropriate; being patient with yourself and surrounding yourself with people who lift you up, is a spiritual practice we all need. “Love is patient,” the Bible tells us. Let us give each other that gift this season, pausing to love, especially when frustrated. Let us give ourselves that same blessing, being patient with ourselves and perhaps in the process we can turn the “because” of COVID into “despite” COVID.

Despite COVID, God still comes, there is still joy, and despite COVID Christmas still brings new light into our dark places. May we find blessings in the waiting.

Kendall Wannamaker, M.D., Carolina Eye Associates | 910-295-2100

EYE HEALTH: FLOATERS AND FLASHES

DECEMBER 2021 - 11 What are floaters?

What are flashes?

Floaters appear as small circles, dots, lines, or cobwebs in your field of vision. There can be a single large floater or many small floaters. Many people will mistake floaters for a smudge on their glasses or a gnat flying by. While they seem to be in front of your eye, the floaters are actually located inside your eye. They are made up of tiny clumps of gel or cells inside the vitreous that naturally occupies the inside of your eye. Floaters are more noticeable when looking at plain backgrounds, like a blue sky or blank wall.

Flashes can look like flashing lights or streaks of lightening in your peripheral field of vision. They can occur in bright and dark environments and can persist (on and off) for weeks, or even months. Flashes happen when the vitreous gel pulls on your retina. They are frequently associated with the development of a posterior vitreous detachment. They can also be associated with the presence of a retinal tear.

Why do floaters occur? As we age, our vitreous starts to thicken and shrink leading to clumps or strands to form inside the eye. If the vitreous pulls away from the back of the eye and retina, it is called a posterior vitreous detachment. Large noticeable floaters and cobwebs typically occur when a posterior vitreous detachment develops. Sometimes a swarm of black floaters can occur during a posterior vitreous detachment as well. You are more likely to get floaters if you: • Are nearsighted (you need glasses to see far away) • Have had surgery for cataracts • Have had inflammation inside the eye • Have had recent trauma to your eye Floaters alone are not vision threatening and tend to fade or go away with time. Severe floaters that impact your quality of life can be removed with surgery, but this is seldom necessary. Importantly, NEW floaters can occasionally be associated with a TEAR in the retina. Retinal tears can lead to a detached retina and loss of vision. The formation of a retinal tear is relatively uncommon, but can only be ruled out with a dilated eye exam with your eye care provider.

When should you call your eye care provider? When you develop a large floater or rush of new floaters in your vision. Flashes of light can be an associated symptom. Also, if you notice a shadow or curtain in your peripheral vision call your eye care provider right away. Eye Words to Know Retina: Layer of nerve cells lining the back wall inside the eye. This layer senses light and send signals to the brain so you can see. Vitreous: Clear, gel-like substance that fills the inside of your eye.

DECEMBER 2021 - 12

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DECEMBER 2021 - 13

GRAY MATTER GAMES

ACROSS 1. Climb up and over again 8. More domineering 15. Attitudes of a culture of era (pl.) 16. Throw 17. Break into pieces (2 wds) 18. Take back 19. Continental money 20. A pint, maybe 22. Asian capital 23. Western blue flag, e.g. 24. Complain 26. Bar order 27. A.T.M. need 28. Unoccupied 30. “It’s no ___!” 31. Slogans 33. Having winglike extensions 35. Arabic for “commander”

36. Ancient greetings 37. Free 40. Spider, e.g. 44. ___ gestae 45. Mechanic’s equipment box 47. “Aladdin” prince 48. “Hamlet” has five 50. Area of South Africa 51. Assayers’ stuff 52. Sounds raucously 54. Howard of “Happy Days” 55. Gold braid 56. Indian dish with seasoned rice and meat (var. spelling) 58. Arranged in rows 60. The alimentary canal 61. One who leads a Spartan lifestyle 62. The milling on coin edges 63. Having lost the most freshness

DOWN 1. Proof of purchase 2. An ancient country in west-central Italy 3. Using something jointly or in turns 4. Coconut palms 5. Says “When?” 6. Basic unit of money in Romania 7. Trellis on which ornamental shrubs grow flat 8. News office 9. “___ moment” 10. Literally, “king” 11. Bubbly drinks 12. To settle a problem

through discussion (2 wds) 13. Champion 14. Having finished one’s active working life 21. Amount to make do with 24. A spoken blessing 25. Agonizing work 28. Calculus calculation 29. Bumper sticker word 32. Affranchise 34. ___ Wednesday 36. 25th U.S. state 37. Long-handled device to grasp hard-to-reach items

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Gray Matter Games Solutions

DECEMBER 2021 - 15 Nothing is cozier or more soothing as winter approaches than warm food and drink. Add a fire, a handknit blanket from Aunt Pat in New England, and a pair of mittens your grandchild crocheted, and your winter blues literally melt away.

Directions

To that end, here are two recipes for spiced cider, the foundational beverage for all things winter and warmth.

2. Reduce heat to medium-low and allow to cook just below a simmer for 30 minutes to an hour.

Spiced Cider with Spirits

1. Add the cider, cinnamon stick, allspice berries, whole cloves, star anise pod and orange peel into a medium saucepan and bring to simmer over medium heat.

3. Remove from heat and add the bourbon. Stir gently to combine.

(i.e., alcoholic)

4. Garnish an orange slice, apple slice and/or cinnamon stick.

Serves 4-6

Notes

Ingredients

• Use the cider with the bits in the bottom of the jug for the best flavor – it might be a little murky but there is depth in those bits.

• 4 cups apple cider • 1 cinnamon stick • ½ tsp. allspice berries • 1/2 tsp. whole cloves • 1 star anise pod • 1 large peel of fresh orange • 4 ounces bourbon

• Use the whole allspice berries if you can get your hands on them. The flavor is worth the hunt. • For bourbon, we’ve had success with both Makers Mark and Gentlemen’s Jack. • For a non-alcoholic version, simply omit the bourbon. This recipe is delicious both ways.

• Garnish: orange slices, apple slices and cinnamon sticks

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