In the multitude and labyrinth of diagnoses and codes that Medicare acknowledges as legitimate diagnoses to provide funding for, one of the most important, but overlooked ones in my 23 year-career working in long-term care is this: Z74.1: Need for assistance for personal care. In previous years, before the coding numbers and names changed—as they frequently do, I recall a variation of this diagnosis at the top of the list for one of my nursing home patients I saw for speech/swallow therapy: self-care deficits. The basis of this diagnosis, and the one described above are the same: the patient cannot take care of their needs without assistance, and it is sometimes used when this deficit is primarily cognitive, not a physical issue.
I remember seeing this gentleman walking nimbly through the hallways in a long-term care facility, appearing relatively healthy, and able to ambulate very well; he even appeared a little spry on his feet. He didn’t seem very old relative to the other residents, and before he became my patient, I always wondered why he lived in that particular facility. He didn’t look like he needed to be cared for.
I learned that he had been impaired by a head injury years prior, and while he didn’t appear to need care, he wasn’t able to take care of himself. He lacked the insight and awareness necessary to meet his physical, emotional and safety needs, and he could not live alone.
If you have ever traveled by air, you have likely heard the admonition during the pre-flight safety drill that, if the oxygen masks drop due to a pressure change, be sure to put your mask on before you help a child, or anyone else who may need assistance.
This advice is often translated into articles advising good self-care: take care of yourself before you try to take care of anyone else. It may seem selfish, but it does stand to reason. If your needs are not met, it is much harder to meet someone else’s needs.
Most people are physically and cognitively able to take care of themselves. Some people, however, do need assistance from others to help them meet their needs. Caregiving is one of the most challenging responsibilities anyone can undertake, and it can take a toll on a person’s well-being if they do not take care of themselves.
Many caregivers feel guilty if they allow themselves time to engage in activities that are not directly an effort to take care of the person they are in charge of. I have seen it many times in my work: the spouse or partner of the person who needs care devotes all their time and energy to ensuring their loved one’s needs are met, while ignoring their own. Too often, this catches up with them, and they find themselves in a health crisis of their own. Sometimes, it is the adult child of the person in need of care who is a caregiver, and they, too, can find themselves in this situation.
Finding a trusted fill-in who can step up and step in to give the primary caregiver a break can be a challenge as well, but there are resources that are available to begin the process of finding help. Home health agencies, senior centers, Area Agencies on Aging and your primary health care provider are good places to start. Some are fee-based; a few may be on a volunteer basis.
Regardless of whether or not you are a caregiver to a person in need, those of us who are fortunate enough to be independent need to take care of ourselves. It is our duty first to ourselves, and also to those who love us to be as healthy as we possibly can. No one else is responsible for you, unless it has been determined that you are the person in need of care. If you have the ability to do so, it is in your best interests for your present and future health—physical, mental and emotional—to use every tool in the shed to practice optimal self-care.
An exhaustive list follows, but even adding one element of self-care to what you are already doing is a step in the right direction.
- Get enough sleep. There is no substitute for good health, and for feeling good. No excuses, no activity you choose to engage in when you should be sleeping is going to help. If you have trouble sleeping, as many of us do, visit with your health care provider. Also, there are many online resources offering sound suggestions on how to get a good night’s sleep.
- Move your body, if you are able. Just like with sleep, there is no substitute. Exercise is the best medicine for most of what ails you. If your mobility is limited due to illness or injury, ask your health care provider for suggestions on exercise programs specifically for those who have limited mobility. Movement is medicine; motion is lotion. Finding an exercise buddy to keep you accountable can help keep you motivated.
- Drink enough water. “Enough” is defined as half your body weight in ounces every day. Most people are a long way from this goal, but anything closer to that is progress. This is good advice unless you are on fluid restrictions from your doctor, in which case they will advise you accordingly.
- Sunshine and fresh air are always good medicine. Your mother knew what she was talking about.
- The pandemic has shown all of us how much we need social contact, and how social isolation is detrimental to good health in so many ways. Reach out to friends, or join a group to make more friends if you need more social interaction. Many other people are looking for friends, too. We all need each other.
- Engage in a hobby you enjoy. Whatever feels good, do more of that. Reading, working puzzles, crafts, knitting, collecting a favorite thing, even watching TV is good for you in the right amounts. If you like to bake, double the batch and give some away. If you feel a calling to develop a hobby into something more, go ahead and write that book or open an online store to sell your crafts.
- Take a vacation. Even if it is only a day trip, take a drive out of town to see some new sights. Pack a lunch if the cost is an issue. Even a drive an hour away will open your eyes to new sights.
- Connect with an old friend you haven’t heard from in a while. If you need to let go of an old hurt, pick up the 500-pound phone and call them. Forgiveness is really about you, not them.
- Get that pet you have been wanting. While they are an obligation in their need for care, they are good medicine, too.
In short, if you know it is good for you, and you aren’t doing enough of it, then DO IT! Some activities like exercising and putting yourself to bed early are hard, watching TV is easy. Find the balance between easy and hard. Give yourself credit for any step in the right direction, big steps and little steps, too.
- The holidays are approaching, and can cause increased, and unwelcome stress for many people. It is okay to scale down, to do less and to let yourself off the hook for gift-giving, baking and entertaining if it doesn’t bring you joy. Just consider it.
Above all, be nice to yourself. Let go of past mistakes, heaviness and hurts, and move forward. You deserve it. You will be healthier for it.