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Archive for the ‘geriatrics’ Category

Last week I was asked as a Caring.com senior expert to speak on NBC Miami Live show and talk to folks in South Florida about how to choose a senior care facility for your aging loved one. Sometimes no matter how much we want to keep our loved one in their own home, or with us, it’s jut not possible. Working caregivers, frequent falls, severe dementia or other round the clock care needs can make it impossible for your loved one to remain with family. If, or when that time comes, it helps to have a plan and to already know your area and what it has to offer for families.

Here is a link to Caring.com’s YouTube channel to view the NBC Miami Live interview:

http://www.youtube.com/user/caringcom#p/u/0/u_8LHy-Cjto

It’s such a big decision and you want to make sure your loved one adjusts and is safe and well cared for. Are there specific points to help guide you through the search? It’s so overwhelming I thought I’d just bring up three key points to help guide you.

3 Tips to Consider When Searching for a Senior Care Facility:

  • Look past the fancy “storefront” and notice how folks are being treated. More and more facilities are beginning to look like country clubs, and that’s great but real care is what you’re after. Look past the golf carts that whiz you in and out, look past the luscious garden-like entrance, past the swanky lobby and even ask to see something other than the staged guest room all decked out with new pictures on the wall and a great view of the courtyard. Ask to have lunch with the residents. Stroll to the community center or gathering room. See if you can go down the hall where your loved one might be placed and see who their neighbors will be.
  • Don’t just take the tour–branch off–ask the residents (and their family members) who live there. Ask the residents if they like the food, if they get their medications on time. Ask their family members if they’ve ever had a bed sore or have problems with any of the staff or other residents. Even if they say the right words, notice how they hesitate, get antsy, or look around as if they’ll be heard. If your loved one has dementia ask to see that ward. Make sure there are safety measures for them not wandering away, and also make sure they are spoken to in a firm but kind manner. Look in their faces and see if they have that hazy drug look. Notice if they’re dressed, if their rooms are tidy, and if there’s a smell of urine in the air.
  • Ask how concerns will be handled, and what you can do if you need to change care facilities. Face it, you’re going to have certain questions and concerns. You’re going to have to ask them if they’ll change something to accommodate your loved one’s needs–that’s just normal adjustments. Find out how that’s handled up front. Talk to not only the day staff, but the night and weekend staff. Ask how they do their background checks and if they’re updated. Ask how you handle serious issues and what happens if you choose to move your loved one to a different facility.

Don’t think that once you move them in that your job as a caregiver is over. It’s not. You’re their care advocate. Visit often and not at the same time. Be cordial with the staff, get to know them and genuinely care about them. Bring in a treat or send them a thank you card if they’ve done something thoughtful or helpful. People respond to positive reenforcement and caring for a (sometimes) cantankerous, sick person who isn’t always jolly is more than a job, it’s a calling. It’s to your benefit to reach out. People who are visited often receive better care, and besides, it’s just the right thing to do.

There’s so much more I could talk about, but this is enough for now. In the end, follow your gut instinct. Stay involved and do all you can to surround your aging loved one with good care–no matter where that might be.

~Carol O’Dell

Author of Mothering Mother, available on Kindle

Got a caregiving question: Send it to me, Carol O’Dell, Caring.com’s Family Advisor at Carol@caring.com

(NBC Miami Live interview is now on Caring.com’s YouTube channel (click on link below):

http://www.youtube.com/user/caringcom#p/u/0/u_8LHy-Cjto

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It’s not that most caregiving families want to, but there may come a time when your spouse’s or elder-parent’s care becomes more than you can physically or emotionally manage at home. Caregivers need to look past the initial bells and whistles of a care facility to make sure that your loved one is receiving the very best care at all hours of the day and night.

How to Choose a Care  Facility For a Loved One:

  • Plan early—don’t wait until it’s an emergency. The highest rated
    care homes usually have a waiting list.
  • Don’t pay for more than you need. Know that cost rises with care needs, so don’t pay for services your loved one doesn’t need–yet. Ask if they have a graduated care situation or whether your loved one will have to find another home if their care needs increase.
  • Consider smaller care facilities or even a group home. Bigger isn’t always better.
  • Don’t get razzle-dazzled by fancy entrances/amenities. Look past all that and notice how the staff interacts with their residents–are they caring, engaged, friendly, and prompt?
  • Visit several times/and several shifts before making your
    decision–and eat the food for yourself–and if you can, talk to a resident or family member of someone who’s already living there
  • Consider visiting with a friend or someone who is impartial and can notice things you don’t want to–or can’t see.
  • Ask other caregivers if they know about this facility and
    “what’s the word on the street?” Check out a care home rating site such as the ones listed at: http://www.consumerhealthratings.com/index.php?action=showSubCats&cat_id=268
  • Check online for more facility information and reviews–Caring.com lists care homes, facilities and hospices in your area–along with helpful checklists and other info to assist you http://www.caring.com/local
  • Does the facility offer family support services, such as caregiver support
    groups and family event days?
  • Discuss how client and family concerns are handled, what is the
    protocol for disputes? Also find out the procedure for how to move your loved one to another facility if that becomes a necessity.
  • Ask about turnover rate of employees and residents. If people are happy–they stay.
  •  Ask how they screen their employees and how often this is
    updated (know that some care facilities allow employees to have misdemeanors, etc. on their record)
  • Ask to view the ACA survey. It will list the facility’s records on everything from safety records, employee issues, MRSA and other infections, bed sores, accident/fall rates.
  • How is orientation handled and what efforts are made to
    integrate your loved one with the staff and other clients?
  • Find out if your spouse/parent’s doctors/hospital serve this
    care facility or if you will have to find all new doctors. (Many physicians or their assistants visit care homes, which can make it easier than your family member having to make a trip into the doctor’s office.
  • Consider location and how often you–and others–can visit.
  • Consider other location factors–should your loved one stay in their own community where they have friends, doctors, and religious support?
  • Never forget that you are your loved one’s care advocate. Stay involved, hang out, and continue to be aware of their physical, financial, and emotional needs.
  • Visit often and make sure it’s not a “to do” session. Caregiving can strip you of your most important role–to be the spouse, partner, daughter or son. Once your loved one settles in, then it’s time to make an effort to be their emotional support–brighten their day by wearing a smile, bringing small presents, taking them outside (if possible) or bringing them home for a few days around the holidays.

~Carol O’Dell

Author of Mothering Mother, available on Kindle

Other great care facility information can be found at:

http://www.caring.com/articles/caring-checklist-evaluating-an-assisted-living-facility

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Now, don’t get upset. I’m not calling you a lousy caregiver, but now that I’ve got your attention, what makes a good–or a lousy caregiver?

So how should we treat those who need a little extra care? How do we show them the respect they deserve? When we get tired, aggravated or frustrated, how do we act? Do we get snippy? Manipulate? Use the silent treatment? Do we bully them into doing what we want? What do we neglect to do when we’re tired? How do we solve conflicts? How do we self-correct?

A big issue for caregivers is separating the need for care from the actual relationship. Who wants to “taken” care of? No one wants to be pitied or felt like a cause.

We have so much to learn from each other. There’s a reason why we care for our mothers, fathers, sister, brothers, children, and close friends. When we come together at a point of need–we see the best–and worst in ourselves. It’s an opportunity to learn and grow, but it’s not always easy! (that’s an understatement!)

When we care for our loved ones, we have to remember that caring isn’t just a list of chores or errands. Caring is about, well, caring. Showing that you care encompasses so much more–spiritually, emotionally, as well as physically.

So who’s a lousy caregiver?

A lousy caregiver chooses not to care. A lousy caregiver can live across the country and never call or come to visit–or they can sleep in the same bed with their spouse and never pay attention to what that person really needs. Most people who avoid caregiving are scared. They say they’re busy, not good at it, feel rejected…but in reality they’re mostly scared. Others, a few, cannot feel or empathize with others. They cannot give freely, make the necessary sacrifices, or understand it’s a priviledge to care for someone you love.

A lousy caregiver thinks it’s all about them. They have what I call “look at what has happened to me–syndrome.” They gripe and complain so much that they don’t think about what their other “person” has endured and survived. Their myopic view of the world does not allow them to see that the world is so much bigger–and more interesting and complex–than they are. They suck the air out of a room and the joy out of your heart–beware!

A lousy caregiver resents caregiving. All of us have those moments–when we wish life were different–we long for freedom, for time, for a five-minute break. That’s not the same. A truly resentful caregiver is bitter, consumed, and sadly, they won’t let go and allow that care person to find better care.

A lousy caregiver uses their care person. Some lousy caregiver are moochers. They move in, take over, and take liberties with the other person’s finances–in general–they’re users and probably always have been. They seem to find people to take advantage of.

A lousy caregiver is verbally manipulative and can even be physically abusive. It’s scary to think about, but they’re out there. They berate people, jerk them around, bully and trick them, and can even hit, slap, or neglect the very person they are to care for. If you know someone who abuses an elder, go to www.elderabuse.gov and find out how you can help and protect this person in need.

If you’re reading this post about caregiving, I doubt you’re a lousy caregiver. You may have lousy moments–we all do–but if you care enough to read a post about caregiving, you’re not the cold-hearted, abusive person I’m speaking of. 

What’s your idea of a “good” caregiver? What do you value?

The good ole’ golden rule teaches us so much. If you were bed-ridden, lost in the confusion of Alzheimer’s, nauseous from cancer, or couldn’t make it up a flight of steps without help, how would you want to be touched, talked to, and cared for?

All of us have lousy caregiving moments. That’s when we have to dig deep and remember in the deepest part of who we are: we’re caregiving because we really do care.

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Just today, I was driving home when I saw an elder-woman walking on the side of a rather busy road. Cars go at least 40 and sometimes 60 mph. on this road. She had no business walking there alone. My husband and I turned around and I got out to greet her.

“Hello, I’m Carol and I live nearby–are you lost?” I asked, trying not to appear threatening.

“Oh no, I’m not lost. I’m walking to meet my daughter.”  Her sharp blue eyes smiled back at me and I thought of my mom and suddenly missed her.

“Where’s your daughter?” I asked. (We live several miles from the nearest shopping district)

“Out shopping. I was hoping I’d see her drive by.”

I asked her where she lived and she said she was visiting from up north but that her daughter lived “back there, behind that gate.” (She must have slipped out of the neighborhood when a car drive through the gate).

I offered to take her home. She got in our car (scary, huh?) We carried on a pleasant conversation. She pointed to her daughter’s house, told me what state and city she lived in up north, and other clear-headed facts.

She was mentally sharp, but she wasn’t making good decisions–her reasoning skills weren’t quite right.

She couldn’t understand that she was at least 2 miles from her daughter’s neighborhood, walking alongside a busy road, and that she really shouldn’t be trying to find her daughter this way–nor is it wise to get in the car with strangers, even though I’m very glad she did, in this particular case.  

I didn’t think “oh bad daughter!” Not at all. I had a mom who insisted she was going to catch a taxi and go to her home. I had no idea how she could even remember the word, taxi, or what it meant but she did.  It took me and my husband and children to keep an eye on her–she was determined to escape!

I took her home. Her daughter drove up within minutes. She had been out looking for her. I left concerned. It’s so so hard to watch someone all the time and never get a break. Her mom was such a vibrant woman, it would be a challenge to keep her from not wanting to strike out on her own–not realizing the dangers she was exposing herself to.

There comes a time when our elders are still smart, together people–great conversationalists and even pretty efficient in their every day lives–but there comes a time when they might not be making the safest decisions, and that might begin to present itself when they’re out of their routine, or when they’re with someone else who isn’t filling in the gaps for them. They can even keep their act together around their kids–because they don’t want to have to move out of their home.

Is this the beginnings of demantia or Alzheimer’s–or is this simply a natural decline of our mental faculties?

That answer is different for each person, but as a caregiver, a daughter, a son, or other family member, we must be diligent in our care for our elders. They can “fool” us, not meaning to. They’re so smart and funny and together–and we need them to be so our world can continue “as is” –and it’s so easy to overlook subtle warnings signs and the beginnings of those unsaid concerns, and that’s when something can happen.

Cognitive and reasoning skills change over time–for all of us.

Yes, it’s wise to get an ID bracelet, to show their names and contact info into their clothing and write it with a sharpie on their shoe or hat, but nothing takes the place of being aware of where your elders are just as mom has to know where her children are.

In Florida, we have the Silver Alert -a system that announces when an elder is lost or wandering and treats it much like a missing child and the Amber Alert system that alerts the authorities and posting it on the news and highways. This program has saved many lifes.

It’s our awareness that keeps our loved ones safe–and sometimes even that’s not enough.

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Patience is something that’s really tested in your caregiving years.

My mother used to take 15 minutes just to cross the parking lot–and that was from the closest handicapped spot! At times, I was so impatient that I can remember feeling as if I would pull all my hair out by the roots. She had Parkinson’s, and changes in flooring (car to asphalt, brick to carpet) would completely stall out her brain. She’d stand shaking, sweating, and sometimes crying. She refused a wheelchair, and although at times it limited where she could go and what she could do, I understood. Perhaps she had too much pride, but at 90, who wants to start working on your pride issues?

Later, my mother developed Alzheimer’s. You talk about one GIANT test in patience, Being a sandwich geneartion mom did and didn’t help matters. I had to be a decent example in front of my girls. The old saying, “What goes ’round, comes ’round,” reminded me that how I treat my mom is how I will be treated. But in my defense, I had three, count ’em three teenage daughters–now that’s not funny! Ever been around a snarly 14 year old girl? I felt pushed to the edge of the cliff. How much frustration could I take without snapping?

I had to learn how to let go and forget about getting somewhere on time, forget about getting dinner on the table. I had to learn how to not let the ten-thousand question game get to me.

 “Just let go,” I used to repeat like a mantra.

I didn’t want my mother to “suffer” because she had a disease. She was suffering enough–in her body, and how she perceived herself. I didn’t need to shame her. I felt like I was right back with my two-year old and we were staring at an earthworm on the sidewalk. You can’t rush a toddler, and there’s something amazing about that. They teach you to slow down, appreciate things, look around.

I used to lean my head on the door jamb and just wait for my mom’s brain to click in gear. Yeah, sometimes I wanted to ram my head against the wood, but what good would that do? After a while, I learned to simply enjoy my thoughts as we waited.

In the movie Evan Almighty when God (played by Morgan Freeman) tells Evan (a modern day Noah) that people ask for virtues such as patience all the time. They think that poof! they’re going to get doused with patience as if were fairy dust. It doesn’t work that way. God tells him that if when a person prays for patience, He is obliged to give them a situation in which to learn patience.

Wow~ I get it. (and I’m going to be careful about my prayers and wishes!)

Here are a few tips I learned about being patient:

  • If I really need to get something done, do it first thing in the day.
  • Get mad and impatient at the disease, not the person.
  • Most things you fret about–being late, not getting something in on time–they don’t matter that much anyway. If they did, would you really have waited til the last minute?
  • Start to enjoy the slower pace. Yes, elders usually eat slow, walk slow, rest more. Is this such a bad thing?
  • Laugh–or cry–whatever will get you though. Our emotions are like a water hose. When they start to flow, knotting up the hose is only going to cause a serious blow out.

Patience is a muscle that gets stronger every time you exercise it, even for just a few minutes at a time. The main person to be patient with–is yourself.

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Caregiving kicks up family igivssues. It just does. We can think we’re over them. We made amends. Asked forgiveness-forgave–and then we find ourselves back in that vortex of anger and hurt. Are we truly able to let go of a grudge?

We don’t like to admit it, but we like our addictions, and yes, a grudge (hurt) can become an addiction of sorts. We grow accustomed to, feel comfortable and safe with our dramas. Why? Because people fear the unknown. Even when the known isn’t so great.

Grudges. We all have them. Hurts from the past. Times our moms or dads weren’t there for us. Times when our siblings belittled us, took something we wanted for their own. Some wounds are profound. Some of us have been molested, raped, endured physical or verbal abuse. It’s not that we’re trying to be difficult. These are valid. They were and in many ways are knife slashes to our soul. And when it comes time to be a caregiver, these grievances resurface and can get in the way–not only of giving care, if we choose to–but get in the way of our own personal growth and healing.

5  Keys to Letting Go of a Grudge:

  1. Admit you have one.
  2. Admit you’re tired of having one.
  3. Stop negative words from coming out of your mouth–mid-word.
  4. Crowd out those hurtful thoughts. When you catch yourself mulling over the hurts of the past–crowd it out with something else–music, go-online and read some jokes, or call an upbeat friend.
  5. Give your grudge a ceremony. Create a campfire and write your hurts on paper and then burn them, or write them on rocks and place them in a rock garden, do something that signifies that you’re letting go of this hurt–and when you start to say or think about that grudge, remind yourself of that ceremony and tell yourself it’s a done deal. That’s why weddings and funerals are a part of so many cultures–they signifiy new beginnings and bitter-sweet ends.

I was watching the film, What the Bleep Do We Know,and I was reminded by one of their neuro-scientists about the power of our frontal lobes. Human beings have a highly developed frontal region, and this region is our seat of reason. We can decide, change our minds, examine, ponder, and observe–all from this vantage point. If our frontal lobes have been damaged, our ability to decide–anything–whether we’d like toast or a biscuit for breakfast is hampered, if not downright halted. 

Deciding what to do with a grudge is a choice.

Have you ever had something, thoughts that consumed you for years–that are no longer a part of your every day life? That means you’ve moved on–and if you did it once–you can do it again. Somehow, you started to choose to view that hurt (grudge) differently. It lost its “umph” as my mother used to say when a Sprite no longer held a zing.

Grudge sounds so negative–sounds like drudge or dredge. Let’s just call it a hurt we’ve been holding onto for a while. I’m not belittling what has happened to you. I have had some pretty decent size  traumas in my life, so I’m not immune to this topic. I take it very serious. It took me years, years to deal with my hurts. Did you know that sociologist’s have found that it takes about 15 years to work through the issues that come with severe traumas such as dealing with a suicide, murder or rape? That’s a lot of time, but if you’ve ever experienced any of these, you know the physical and psychological toll it took on you.

Why do some people absorb their pain, use it in some  way for the good, incorporate it into their being, and in essence, “move on” when others seem stuck in anger, regret, and seething pain for the rest of their lives?

I don’t know the answer to that.  I don’t think it’s because one person is better or stronger than the other.  I do believe it’s in part, a choice–even when they don’t realize it. I think it’s because the light bulb (understanding, revalation) hasn’t been turned on–yet. It’s part of their journey, and I love the saying, “If I’d-a known better, I’d-a done better.”

But I do know that people are capable of change–great change. Sometimes the shackles that had us so pinned down one day simply fall to the ground. 

For me, I think I wore out my anger and hurt. I got  sick and tired of being sick and tired as Oprah says. My angry, pitiful story of how I was hurt was no longer a story I wanted to tell. I started to observe that people didn’t want to be around me when I was complaining. I could taste my own toxins and I was turned off by what was rolling around in my thoughts and falling off my tongue. 

I began to want to be well. I started by controlling what came out of my mouth. Not easy. Lots of start-overs.  I wrote down my hurts, said a prayer, sometimes burned them on pieces of paper, ready every self-help book under the sun. My awareness and desire to change was at least a start.

There were times when caring for my adoptive mother (who had Alzheimer’s and Parkinson’s) was difficult. Buttons got pushed and at times, I felt right back in that quagmire of the anger and pain I thought I had dealt with years ago.  But I found that I chose not to stay there, in my complaining, nasty, negative self. I didn’t want my grudge any more. I didn’t identify with that part of my past. It wasn’t that “we,” my mother and me were completely fixed and all was magically erased–it wasn’t, and I didn’t want it to be. I could accept who we were, what we had done to ourselves and each other, and I could see that we were no longer those two same people.

If you’re reading this, then maybe you’re ready to let go of some of that back of the closet crap you thought for some reason you had to hold onto.

It’s a new day when our grudges no longer bring us comfort. A new self is emerging.

~Carol O’Dell

Author, Mothering Mother

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You’re stuck at home caregiving. You can’t come and go as you please. Your loved one could fall, can’t go to the bathroom without you, is afraid when you’re gone. You find yourself envying neighbors walking out their front door and getting into their cars–such a simple and easy thing for most people to do. Not you. The days feel long and exhausting.

I know, I ‘ve been there. When I first moved my mother in with my family and me, I could get out–some. She didn’t like when I left her at home, but at least I could go to the grocery store and take an extra 15 minutes to stop by the library. I could also take my mom out–but that took more than an hour to get her ready, another 15 minutes to get her in the car, and that doesn’t count the time needed to get her out of the car, into a store, out of the store.

Oh shoot, forget it, was what I wound up saying a lot of the time.

I tried to take her out, stimulate her interests (and mine), meet new people and do what we women love to do–shop. It was just so exhausting.

It’s hard to wake up and face a new day–some days–as a caregiver. My mother had Parkinson’s  and Alzheimer’s. Meds needed to be started early if we had any hopes of having a “good day.” She was hungry early, too. I tried my best to have coffee and bit of “me” time (journaling, stretching) before she heard me. I even bought a small coffee pot for my bedroom. Once my mother saw I was up, it was all over. I think she laid in bed and planned out how to order me around all day. That woman had a to-do list a mile long. “Nip it in the bud,” was her motto.

The thought of every day all day at home felt like a prison sentence. No ankle monitor could have kept me more chained. But I learned how to make it work in my favor. I learned in caregiving you have to turn things around and find the good.

When you think about it, most people would LOVE to be at home (or so they think). One day, I decided to stop dreading it.

How to Find Adventure in Your Own Home:

  • Get cable, or the Dish. Television is a link to the outside world. Don’t watch the news (too depressing). Watch the Food Channel, HGTV, or Discovery Channel. Use it to educate yourself. Use it to entertain yourself. Pay a bit more for more channels. They’ve got yoga, old movies, religious channels, sports–whatever floats your boat. You can preach all you want about mindless television, but if you use it right, you can keep yourself company and even learn a thing or two.
  • I took a daily yoga “class” on tv, learned to cook Southwest foods, became a Paula Deen aficionado, and found some great old movies my mother really liked.
  • Got books? I bet you do. You probably have books you haven’t read or barely skimmed. Pull one off the shelf. One a week, in fact. Educate yourself by catching up on what you already have.
  • Got unfinished projects? I sure do. It may take you ten times longer (being interrupted all the time), but why not spread out an art project on the diningroom table and work on it 15 minutes a day.
  • Sign up for an online class. Yes, you’re under house arrest (so to speak), but that doesn’t mean you don’t have access to the world. They don’t call it the World Wide Web for nothing! There’s a class for everything–university level to hobby enthusiast level.
  • Go to a caregiver’s group with an agenda–to make friends. Start a caregiving co-op. Find someone nearby and agree to “mom sit.” Even once a month gives you a day out you don’t have now–and with a fellow caregiver who knows the ropes. Also, trade phone numbers and start calling each other. Remember when you were a new mom and needed a friend? Same thing, make a call and start up a conversation with someone you already have something in common with.
  • Buy magazines. I kept myself inundated with new material. Learning is something you can easily do right at home. Step outside your comfort zone and get a magazine you’ve never bought before–Kayakers, Digital Photography, Psychology, Dog Fancy, you name it and there’s a magazine out there. So it adds ten dollars to your grocery bill. Better ten dollars in beautiful visuals, interesting articles and a chance to daydream is a far better use of your money than Paxil and Zoloft (which ten dollars won’t’ get you much…and if you need them, they’re a godsend).

These are just a few suggestions to help you focus on something other than caregiving. You’ll actually be a better caregiver by cultivating and maintaining your own interests. Resentment, guilt and frustration build when you give yourself no outlets.

Yes, it all takes energy–something you don’t have much of, you argue. You have more than you think. Your exhaustion has more to do with being apathetic (depressed, angry, frustrated–pick your adjective). It’s not all physical. The body (and mind) is resilient–and when you give it a purpose it can endure, persevere, and find untapped sources of joy and enthusiasm you didn’t even know you had.

These were some of my solutions. I hope you find your own. Find your path through caregiving and share your secrets with others. Don’t stop being you. In fact, this caregiving “cocooning” time is quite valuable to you. Yes, you may be pretty much “stuck at home,” but it’s not all bad. Change your perspective and begin to see all the opportunities and adventures you can have in your own four walls (and your own backyard).

What if…you could come out of caregiving renewed and reinvented…What if, caregiving worked in your favor? 

~Carol O’Dell

Need a good read? Check out my book, Mothering Mother

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