Richmond Carers Centre Fact Sheet No.3 Taking Care of Yourself

Being a carer can be very demanding and it can affect your own health. You Index need to maintain your own health, as this will make a difference in the overall way you cope and how you feel about life in general. It is also important to remember that if you do not look after yourself you may find you cannot cope Page 1 so easily with caring for someone else.  Healthy Diet  Sleep Many people will be become focussed upon the person they are caring for and Page 2 how to manage their health needs. However, do not ignore your own health  Physical needs. Do not put off seeing your doctor and ensure you take every opportunity Health to have the appropriate health checks. You should inform your own doctor that  Back Care Page 3 you are a carer as this will give them a clearer picture of the stress that you may be experiencing and the importance of maintaining your own health.  Emotional Health & Well Being Healthy Diet Page 4 It may seem obvious, but many people do not maintain a good diet when they  Stress are busy caring for some one else. If you are too busy it becomes easy to skip  If You Are Ill a meal, not take the time to prepare a meal for yourself, or even you may be  What You Can finding that you are simply too tired to eat. A balanced diet will supply you with Do to Help Yourself energy and keep your immune system healthy enabling you to fight off some of Page 7 the colds and viruses that may be around.  Who Can Help You It is recommended that you prepare a meal using food from the four main Page 9 groups:  Useful  Starchy foods (Choose whole grain breads where possible) Resources  Dairy foods (2-3 servings a day)  A small portion of meat (2-3 ounces), poultry or fish (4-5 ounces)  Vegetables and fruit (recommended 5 portions a day) Sleep Many carers go without a good nights sleep either because you are too stressed to relax or because the person you are supporting needs help throughout the night. In the short term you may get away with this, but in the long term this will have an adverse effect on your health so it is important to try to control your sleep pattern if you can. Once you enter into a regular pattern of sleep it can be very hard to change; so if you have been used to getting up at 2am to help someone you may find that even on the occasion you do not need to do this that your body naturally wakes itself up. If you have entered into one of these cycles and cannot change it yourself it may be an idea to discuss it with your GP or local pharmacist who may have some alternative solutions.

You may like to try one Richmondof the following Carers Centre, before 5 Briar Road,you Twickenhamspeak to TW2your 6RB. GP: Tel: 020 8867 2380 Richmond Carers Centre is a Company Limited by Guarantee with Charitable Status Charity No. 1092459 Registered in England Company No. 4412793 The Princess Royal Trust for Carers is a Registered Charity No. SCO15975  If you have trouble getting to sleep, don’t go to bed too early. Disclaimer: Although the information provided is carefully checked, Richmond Carers Centre cannot accept liability for any inaccuracy or omission. Richmond Carers Centre does not recommend any product or service and the views expressed in this document do not necessarily represent the views of the organisation.

Last Reviewed: May 2007 www.carers.org Last reviewed: Feb 07 www.carers.org  Don’t snooze during the day unless you know you are going to be kept awake at night.  Establish a good bedtime routine. Avoid alcohol, have a warm drink and a bath and make sure the bedroom isn’t overheated.  If you like to read before going to sleep, choose something soothing. If you like to listen to the radio, play some music rather than listen to the late-night news  After you switch out the light, try some visualisation techniques to occupy your mind. For instance, imagine an idyllic beach scene. The sun is warm, the sea is blue, and you can feel the sand on your bare feet.  If you wake in the night and find your head is full of worries, try spending an hour or so out of bed, or sitting up with the light on if you sleep alone.  You can read, do the ironing, watch television or write down everything that’s on your mind. You’ll find these are preferable to tossing and turning in the dark. Physical Health Moderate regular exercise will help you in a number of ways:

 Improved energy levels  Improve you ability to sleep  The increase in the endorphins in the blood stream will reduce any depression you may be experiencing.

Exercise doesn’t have to be extreme, just regular. Try to introduce a routine that you enjoy, such as a regular walk. You may like to join a local gym or class to help you remain motivated. Do remember though that if you have not exercised in a while you should consult your GP to ensure you are not going to do yourself more harm than good.

LBRuT Health Walks are organised walks led by trained volunteers for people who are currently not very active but would like to do more. These gentle walks take place in groups and provide a safe and social atmosphere. The current walks are generally between 45-70 mins long and with at least two walk leaders at the front and the back, people are encouraged to go at a pace that is comfortable for them.

For further information contact the Health Development Team Tel: 020 8891 7445 Email: [email protected] Web: www.richmond.gov.uk/health_walks Back Care Back pain is common among carers. Nurses and care assistants never lift anyone on their own but most of the time, as a carer, you will have no choice. Even helping someone to dress or move from bed to chair can take its toll on your back. Ask your GP to refer you to the district nurse or community physiotherapist. They can visit to assess your needs and also show you the correct way to lift and move someone safely and minimise the risks. When you move someone:

 Allow the person you care for to help themselves as much as possible.  Always tell them what you plan to do and always leave plenty of time in which to do it.

Richmond Carers Centre 2 of 9 Fact Sheet No. 3  If you have back pain, don’t ignore it. Your GP may prescribe anti-inflammatory drugs to calm strained muscles. There is no need to be immobile. Very gentle stretching exercises will help your muscles to relax. But avoid lifting while your back is in pain. Think about getting some lifting and turning aids to help you. An occupational therapist can advise on what is most appropriate.  If a person has fallen and there is no obvious injury, but you feel you are unable to help the person you can still call for an ambulance for assistance by dialling 999. While you wait try to make the person as comfortable as possible using soft pillows and blankets to keep them warm.

Here at Richmond Carers Centre we organise access to local back care training. Information on this can be found in the Training Programme circulated through our newsletter. For further information on back care see the section on “What You Can Do to Help Yourself”. Emotional Health and Well Being Carers often have to cope with many conflicting feelings. Being a carer can be rewarding but it can also be demanding and frustrating. Along side the positive moments there may be many painful feelings. Often the way you feel may be influenced by how you began caring – was it a choice you were able to make freely or are you in a situation that arose from circumstances? It’s important to recognise that you can love someone and still feel angry, guilty, depressed or resentful. These feelings are normal. You may find you can deal with them by acknowledging, ‘Yes, I feel angry because…’ Or you may prefer to seek some-one to talk to such as a trained counsellor or another carer.

At the same time you may have positive feelings of love or satisfaction that you are doing your best, and it helps to share these too.

When you are a carer it often seems as if everything revolves around the person you care for. It’s useful to remember that you also have some basic needs – privacy, a little personal space, time to be with friends and time to laugh and have fun.

Here are a few ideas:

Try to make time for yourself every day. Perhaps you can get up a little earlier for a peaceful cup of tea on your own before everyone else wakes, or it may suit you better to go to bed after everyone else but still have time for an undisturbed soothing bath. If that’s not possible, see if you can make time for a quiet cup of coffee after you’ve finished your morning routine.

 Share your feelings with other carers by joining a local carers’ group.  Take up a hobby. You may not be able to go out to classes but many things can be enjoyed at home.  Lower your standards occasionally – try not to aim for perfection.  If it’s difficult to get out, keep your social life going by using the telephone or writing letters to keep in touch with friends and family.  If you hesitate to leave the person you care for, it’s worth considering whether perhaps they too may need time to themselves.  Do not be afraid to seek, or accept, help.

Richmond Carers Centre offers the opportunity for carers to talk on a one to one basis with a Carers Support Worker to talk through many of these issues. Through these sessions we can also refer you on

Richmond Carers Centre 3 of 9 Fact Sheet No. 3 to other services we can offer such as Counselling, Art as Therapy and Complementary Therapies. If you would like to speak to someone please call our Carers Support Line on 020 8867 2380. Stress Recognising the signs We all need a certain amount of stress in our lives to give us the stimulation to keep going. In a positive way, stress keeps us alert and interested. In a stressful situation, the body responds by preparing to resist or avoid danger – the ‘flight or fight’ response. The heart beats faster to ensure oxygen is reaching all parts of the body and the muscles tense for action. Once the threat has passed the body returns to normal. However, in everyday life, we do not often need to use our ‘flight or fight’ response literally. When there is no physical outlet, the body can remain in this state of extreme alertness for a long time. Eventually the effects of this bottled-up stress are felt both emotionally and physically.

Physically, prolonged exposure to stress can cause:  headaches  insomnia  digestive problems  raised blood pressure and contribute to the development of heart disease  make an existing problem such as eczema or asthma worse  it may also lower resistance to infection.

Emotionally, when you are constantly under stress you may feel exhausted, confused, depressed and agitated and find it hard to make decisions.

If you are ill Carers tend to carry on regardless through colds, coughs, headaches, stomach upsets, flu and worse, but don’t put off seeing your doctor if your headache or cough persists, if you feel faint or dizzy or if you have unexplained pains. Even with a minor illness, try to take some extra rest. Your body will have a better chance of making a quick recovery and there will be less chance of complications or the illness lingering on.

While you are ill, it may help to take a general multi-vitamin supplement and additional vitamin C to boost your immune system and make up any deficit, particularly if you are not eating a great deal. And, of course, the sooner you see the doctor about unexplained symptoms, the more quickly and effectively they can be treated.

If you care for someone who is over 18 and you have recently had a Carers Assessment you may like to apply for a Carers Emergency Card which is a scheme run by the LB Richmond upon Thames. This is a card you can carry yourself and if you are taken unwell this card will help to identify that there is someone at home that you are caring for and may need assistance. For further information contact our Carers Support Line on 020 8867 2380.

What you can do to help yourself

Richmond Carers Centre 4 of 9 Fact Sheet No. 3 Dealing with Stress There may be problems that need solving and feelings that need to be expressed, but in the mean time both exercise and relaxation techniques can help relieve stress. Exercise allows you to channel some of that pent-up frustration into physical activity and can help overcome tension and sleep problems.

Massage can relieve a great deal of tension. A massage once or twice a month with soothing oils from a trained masseur would be the ideal, but self-massage is also helpful. Sitting quietly in a chair and placing your hands on either side of your forehead and rotating them gently can soothe a stressful headache. Exercise like yoga, with its emphasis on relaxed breathing, can help.

Relaxation techniques are a really good way for carers to take time out for themselves.

Remember: Choose what is right for you, what you feel comfortable with. Some people find it easier to deal with stress through physical effort – for them relaxation through sitting still is hard to achieve. For others, simply learning how to remain still for 10 or 15 minutes can bring a sense of peace and calm.

A simple relaxation technique: It’s hard to unwind properly when life is fraught, but a good relaxation technique can make a difference. Rather like physical exercise, relaxation recharges your batteries and offers you a little space in the day that is just for you.

There are many different techniques that you can learn. Some of them involve tapes or joining a class.

The following is a simple form of meditation that you can try at home:

Set aside some time when you know you will not be interrupted. Make sure you are warm and wear comfortable, loose-fitting clothes. Take off your shoes. If it’s daytime, draw the curtains and perhaps light a candle and/or an incense stick. Either sit in a comfortable chair or lie on the bed or floor on a thick blanket. Take several deep breaths, each time breathing more slowly and deeply until you feel comfortable holding the breath for a count of three before letting go.

Then choose one of the following:

Tense and relax each part of your body. Start by tensing up your feet, hold the muscles tightly for a moment, then let go. Do the same for the muscles in your legs, then your stomach and bottom, hands and arms, your shoulders and finally your face and neck muscles. Each time you let go, breathe slowly two or three times and concentrate on how heavy your limbs feel, before moving on to the next part of your body. When you relax your face, make sure your lips are slightly open and your tongue is resting lightly on the upper teeth. Keeping your eyes open, use the lighted candle or a single flower to focus on. Examine it closely, watch the way the flame moves as you breathe or the way the petals are formed, their colour and texture. Imagine yourself in the centre of the candle or flower – warmed by the flame, enveloped by the petals. Choose a word or phrase that either has meaning for you, such as a prayer or the first line of a poem – or a sound that you can repeat that has resonance such as ‘aaah’ or ‘om’. Repeat the phrase or sound over and over until your head is filled with little else. It isn’t easy at first and other thoughts intrude, but in time, if this form of relaxation is right for you, the thoughts will go away. Taking a break

Richmond Carers Centre 5 of 9 Fact Sheet No. 3 You need to take the occasional break. Often this is hard to organise if you are caring on your own and have no family or friends to take over. You may also get into the habit of not having time off or you may feel strongly that you are the only person who can do the caring job. The person you care for may also make things difficult by refusing to let anyone else but you do the caring. These problems need to be resolved because having time off, even just a few hours, is important. Respite care is available for carers. However, provision may be thin on the ground and you may have to fight for it. It can range from someone coming in to be with the person needing care for a few hours, to day-care away from the home once or twice a week, to a residential break or holiday in adapted accommodation for the person needing care. If the person you care for disturbs your sleep night after night, you may be able to have a night-sitting service once or twice a week to allow you to catch up on your rest. There are also schemes known as Home from Home run by social services departments in which carefully vetted local families take elderly people into their own homes as though they were part of the family and offer long- or short-term care. Remember Plan ahead. Don’t wait until there is a crisis or until you are too exhausted to carry on. Get your request for respite in well before you need it. Who to approach To find out about respite care, contact your local social services department and local groups such as Age Concern, Crossroads and Community Service Volunteers. You will find their addresses and telephone numbers in your local directory or speak to our Carers Support Line on 020 8867 2380. Complementary therapies Complementary therapies can work well alongside conventional medicine and help us to overall health. Practitioners of complementary therapies use a holistic approach, in which the whole person is looked at, not just a particular symptom. This is particularly suitable for carers, for whom ill health may be closely connected to the strains and stresses of their caring role. (It is always wise to consult your GP before starting any such therapies if you have any existing health problems or you are taking any medication to ensure it will be beneficial). Richmond Carers Centre runs a complementary therapy service offering carers registered with us 12 weeks of free therapies (donations welcomed). For further information contact our Carers Support Line on 020 8867 2380. Homeopathy The idea of homeopathy is to boost the body’s defence system by using diluted natural substances. Treatment is gentle and the doses are safe. Although homeopathic remedies can be bought in most pharmacies and health stores, the treatment is most effective when prescribed specifically for you by a homeopathic practitioner who, as well as talking to you about your medical symptoms, will also note details of other factors such as your personality and lifestyle. Homeopathic remedies seem to be particularly effective for stress-related problems, allergies such as hay fever, irritable bowel syndrome and migraine.

Institute for Complementary Medicine, For information send an sae and two loose first class stamps.

British Homeopathic Association, 27a Devonshire Street, London W1N 1RJ. Tel 0171 935 2163. Osteopathy and chiropractic

Richmond Carers Centre 6 of 9 Fact Sheet No. 3 These are the best known therapies for back pain – one of the most common problems for carers. Both therapies specialise in the diagnosis and treatment of disorders of the joints and muscles. They use manipulation techniques to reduce pain and improve mobility and function. There may also be additional beneficial effects for people suffering from constipation, irritable bowel syndrome, migraine or headaches as muscle spasm is released. It may be possible to be referred for this treatment by your GP.

Osteopathic Information Service, PO Box 2074, Reading, Berkshire RG1 4YR. Tel 0118 951 2051. Send an sae for a list of local practitioners.

British Chiropractic Association, 29 Whitley Street, Reading RG2 0EG. Tel 0118 9757 557.

Acupuncture Acupuncture forms part of traditional Chinese medicine and involves placing needles at certain points in the body. The theory is that by unblocking the meridians (pathways) that distribute energy (chi) throughout the body, acupuncture re-establishes the balance between yin and yang and thus allows energy to flow freely through the body.

Acupuncture seems to be particularly effective for pain relief but some people find it helps relieve migraine, asthma, joint pain such as arthritis and digestive disorders. Others have reported that it has also helped with emotional problems such as anxiety and depression.

British Acupuncture Council, Park House, 206-208 Latimer Road, London W10 6RE. Tel 0181 964 0222. Send an sae for a list of local therapists.

Aromatherapy The healing properties of essential oils extracted from flowers, leaves, seeds, fruit and bark can alleviate stress and tension. An aromatherapy massage is one of the best treats of all. Failing that, the essential oils can be used in various ways at home. A few drops can be added to bath water to give a relaxing or revitalising bath or the oils can be used in a burner. Remember, essential oils are very strong and must never be swallowed or used undiluted.

Aromatherapy Organisations Council, 3 Latymer Close, Braybrooke, Market Harborough LE16 8LN. Tel 01858 434242. Send an A5 sae for information

Who can help you?

Richmond Carers Centre 7 of 9 Fact Sheet No. 3 Often carers feel very isolated but there are people out there who can help. However, in most cases, you will have to make the first approach.

Your GP If you have the same GP as the person you care for it will be easier for them to be up to date with what’s going on. However, you may prefer to have a different GP, as you may feel more at ease talking about things that worry you. Your GP is the gatekeeper to other health professionals such as consultants and hospital specialists.

They can also help organise specialist nursing care at home or in a residential setting as well as respite care. They can refer you to, or you can contact directly: district nurses; health visitors (increasingly they no longer specialise just in care of young children); community psychiatric nurses; occupational therapists; and physiotherapists. Your GP practice or health centre may also have a social worker attached to it.

Social services Your local social services department is the place to go for information and general advice. You will find the number and address in the local telephone directory. Among the staff provided by social services are: Care managers (sometimes called case managers) who specialise in care in the community and co- ordinating services.

Social workers who can also tell you what is available locally and organise practical supportive services such as meals on wheels, a break from caring and advice on adapting or altering the home. They should also be able to tell you what allowances and benefits you and the person you care for are entitled to.

Under the Carers Act you, the carer, are entitled to ask social services for an assessment of the care you provide. This is called a carer’s assessment. You can ask for a carer’s assessment when the person you are caring for is being assessed. If they have already been assessed, but the situation has now changed because they need more help or you are finding it difficult to manage, ask social services to carry out a reassessment (a review of their needs).

While the Carers Act entitles you to your own assessment, services are provided to the person you care for. However, if they are provided with a good range of services, these in turn will support you.

Carers’ groups Other carers are in a good position to offer advice and support. Those who are caring for someone with the same illness or disability are likely to have good ideas and tips on making life easier. Local carers’ groups are not only places where you can meet people, they often also hold talks and training sessions on subjects such as lifting, coping with incontinence, difficult behaviour or feeding.

Here at Richmond Carers Centre we can support carers who either live in, or care for someone who lives in, the LB Richmond upon Thames. We offer advice on local services and put carers in direct touch with more local Centres if they live outside the Borough. Contact our Carers Support Line on 020 8867 2380.

Nationally you can call the Carers Line on 0345 573 369 (Monday-Friday, 10am-midday and 2-4pm) which is run by Carers National Association. Voluntary organisations

Richmond Carers Centre 8 of 9 Fact Sheet No. 3 If the person you care for suffers from a particular illness or disability, find out if there is a voluntary organisation that can help. At the very least you may be able to get leaflets and brochures or a helpline.

Making the most of what’s available In an ideal world carers, and those they care for, would receive exactly what they need, when they need it. Sadly life isn’t like that, so here are some tips on making the best of often scarce resources.

Think about what you need. Be flexible in your thinking and be prepared to offer alternatives Make your needs clear so that you are not forced to accept an unnecessary or unsuitable service, as this can be embarrassing or irritating. Don’t hesitate to ask for help from different sources – family, friends, voluntary groups, local place of worship. Don’t take no for an answer – ask and keep asking

Useful Resources:

Richmond Carers Fact Sheet No.1 – Useful Local & National Organisations

Useful Web sites: www.stressbusting.co.uk www.stress-counselling.co.uk www.stress.org.uk

How to contact us If you wish to register as a carer or would like further information please contact the Richmond Carers Centre on 020 8867 2380 or email [email protected] or visit www.carers.org/richmond

If you need this information in another format please contact the Richmond Carers Centre on 020 8867 2380

Richmond Carers Centre 9 of 9 Fact Sheet No. 3