Editor’s note: The Caregiving Chronicles blog has partnered with Century Health Systems to bring additional expert information and advice to the MetroWest caregivers we strive to serve at CaregivingMetroWest.org.

Century Health Systems, the parent corporation of Distinguished Care Options and the Natick Visiting Nurse Association, has allowed Caregiving Chronicles to get some valuable insight from its staff for our ongoing series of Q&A sessions with caregiving experts. In this entry, we cover some of the issues facing family caregivers during the holiday season. Providing insight is Judith Boyko, MBA, MS, RN, who has served as the CEO of Century Health Systems since it was established in 2001.

Boyko holds a Bachelor of Science degree in Nursing from the University of Pittsburgh, a Master of Science in Public Health from the University of Massachusetts, Amherst and a Master of Business Administration from Clark University. She has been recognized by the Home & Health Care Association of Massachusetts as Manager of the Year in 1997 and received the Deborah Blumer Community Health Leader Award from the MetroWest Community Health Care Foundation in 2007. She can be reached at info@natickvna.org or 508-651-1786.

Caregiving MetroWest: What are some strategies for coping with the stress that often comes with the holidays?
Boyko: Coping with stress is especially challenging during the holidays. Many of us feel the pressure of having guests in our home, attending celebrations, cooking, or traveling. There’s the financial piece that goes along with that stress; and, being a caregiver while juggling these other responsibilities can be especially overwhelming.

So how can we deal with that stress? Reach out and ask for help, which can come in the form of therapy, help with shopping or cleaning the house, or even volunteering at a local organization that helps others.

CGMW: Taking care of yourself is vital for caregivers to be able to care for their loved ones, but the holidays can be challenging for anyone to maintain a decent diet, get enough rest and find time to exercise. Any tips for caregivers to help keep themselves healthy over the holidays?
Boyko: People who care for others tend to put themselves last. It’s important to feed your body and soul; and caregiving only drives that point home further.

Feed yourself – literally. Eating well helps you to maintain a healthy weight; it also keeps your blood sugars regulated so that your mood doesn’t dip when you’re hungry.

Take breaks. Call a friend you haven’t spoken to in a while. Go for a short walk. Take a nap. Harvard Medical School, in its Harvard Health Letter, says that a 20- to 30-minute nap may be the ideal pick-me-up. Even napping for just a few minutes has benefits.

Drink water to stay hydrated. The Mayo Clinic addresses why water is important and how much you should drink daily.

Finally, accept that it’s OK to say “no.” You don’t have to cater to everyone’s requests; you don’t have to attend all of the celebrations to which you’re invited; and you don’t have to stretch yourself so thin that you’ve got nothing left for yourself at the end of the day.

CGMW: How can ssandwich generation caregivers balance making the holiday special for their children while also caring for their parents?
Boyko: The key word in your question is “special,” not perfect. I like that! We all have to think about letting go of some of the stresses that both caregiving and the holidays bring and try not to expect a picture perfect holiday. “Special” is absolutely good enough!

Some tips on the balancing act of caring for elders and children during the holidays:

•    Order holiday foods in advance. Rather than slave away in the kitchen, find a reputable caterer or specialty food store and order some of your favorite side dishes for delivery or pick-up.
•    Let your kids shop for their gifts. Give them a budget and a stack of catalogs, and let them pick out what they want. It takes the pressure off you, and it’s exciting for them to pick out what they want!
•    Treat yourself. If your kids are old enough, ask them to spend time with your parents and share their life experiences. It will be enriching for everyone involved, and you can take that opportunity to go out for a massage, meet a friend for coffee or even sneak away to a movie.
•    Seek professional caregiving help. Home care agencies can provide home health aides and/or companions to spend time with and support your older loved one while you focus on you or your kids.

CGMW: The holidays often provide an opportunity to spend more time with relatives and friends. For caregivers, that can create an opportunity to make those other relatives and friends aware of how much you’re doing as a caregiver and perhaps solicit some much needed help. Do you have any suggestions for how to broach this sometimes difficult topic and get some assistance?
Boyko: Most of us have trouble patting ourselves on the back. But when it comes to caregiving, your family and circle of friends should be appraised of what you’re doing so they can help you make critical decisions when necessary; step in and offer support; and lend any professional insights they may have as medical practitioners or attorneys, for example.

Having a conversation isn’t the hardest part about sharing what you’re doing – it’s starting that conversation. PBS Newshour published a few guidelines to follow in a family meeting in its article, “A sibling’s guide to caring for aging parents“:

•    Set an agenda for the meeting and keep to it.
•    Focus on the here and now. Try not to bring up past or unrelated issues.
•    Share your feelings with siblings instead of making accusations.
•    Listen and respect the opinions of all participants. Give everyone time to speak.
•    Share all information. If possible, get a professional assessment of your loved one’s condition from a doctor, social worker or geriatric care manager and send the report to all participants before the meeting.
•    As time goes by, use email, online care-sharing tools, conference calling and/or in-person family meetings to help keep everyone abreast of care issues and information.

It is critical, too, that the person you are discussing be part of the conversation. “The care recipient’s wishes and priorities are the cornerstone of every family caregiving plan,” according to AARP.

Finally, don’t forget that “the conversation about caregiving is more than one exchange. It is a discussion that takes place over time. It is never too early to start talking,” according to AARP.

CGMW: Some long-distance caregivers will get a chance to visit with their loved ones during the holidays. What should they try to do while they have the chance to visit with the person they’re helping to care for? How should they assess how their loved one is faring?
Boyko: Rather than falling into a reactive response, be proactive in the care you are providing – even if it’s from a distance. Take advantage of your time together and help your loved one prepare files with all of the necessary and important information they may need, including: medical conditions, medications, physicians’ names and contact information; insurance name, policy number and phone number; legal documents, including advance directives, Social Security cards or numbers, car titles and home deeds.

Prior to the visit, discuss with your loved one the things you want to accomplish while visiting. This can include the list above as well as going through mail and/or paying bills; helping out with manageable projects around the home; and going to the supermarket to stock the kitchen, for example.

To determine how your loved one is faring, talk to them about their social life. Are they getting out and spending time with friends? Do they go to the local senior center to participate in healthy activities and programming?

Discuss their finances. Are bills accumulating? Are late fees accruing?

Observe the house both inside and outside. How does it look? Are things in disarray? How is the lawn? Does it need to be mowed?  Is garbage piling up?

Bottom line: make sure your loved one isn’t lonely, ill or otherwise in any immediate danger.

CGMW: Spending time with the family can be one of the most rewarding aspects of the holidays. It can also contribute to the stress level. Do you have any tips for caregivers dealing with family conflict during the holidays?
Boyko: The National Communication Association provides some very basic but helpful tips to avoid family conflict: “de-emphasize the materialistic aspect of the season;” be cognizant that family members may need some alone time, away from the hubbub; try to forget about your differences; and make a concerted effort to not fall into the bad patterns that repeat themselves year after year.

Some other tips include focusing on the positive things happening in your family; trying not to feed into any of the negative going on around you (even it’s just for a short time); asking for help, which encourages teamwork and can create a sense of bonding; and knowing your limits.

CGMW: Are there any particular strategies for those caring for a loved one with Alzheimer’s or another dementia during the holidays, when crowds, noise and disrupted routines can heighten confusion and anxiety and maintaining familiar traditions can be especially difficult?
Boyko: First, find out when the meal will be served, and try to arrive with your family member right before the meal. If you get there at the beginning of the party, they may become overwhelmed from the stimulus and want to leave before the meal is served.

Some other tips:

•    When you arrive, show them where the bathroom is, and make sure they’re wearing clothing that’s easy to take off for toileting.
•    Have the person sit in a quieter place away from the activity and have relatives visit one at a time, bringing things to show or talk about. Your loved one may also enjoy showing others a photo album or puzzle they’re working on.
•    Set a schedule so that you can enjoy the celebration, too. Ask a relative to give you a break for a little while, and say something like “I’ll be there for whatever mom needs until 3 p.m. I’ll need you from 3 p.m. to 4 p.m.” Remember, it’s your holiday, too.
•    Let family members know about your relative’s diagnosis. If they haven’t seen “Grandma” for a while, they may be surprised at the change.
•    A great book that helps to teach kids about Alzheimer’s is Maria Shriver’s “What’s happening to Grandpa?”

CGMW: Last, for those who may be reading this who are not primary caregivers themselves, but know a family member or friend who is fully immersed in caring for a loved one, what are some suggestions to show some appreciation for those caregivers at this time of year?
Boyko: There are so many wonderful ways to thank a caregiver:

•    Give a gift card
•    Take them out for lunch
•    Provide a service, like walking their dog or going food shopping for them, while they take a break
•    Make a donation in their name to a charity of your choice
•    Give them a day off; consider hiring a professional caregiver to take on their responsibilities for a few hours – or days!

•    And the most basic thank-you can come in the form of a hand-written note. They will appreciate the time you took to thank and acknowledge them.