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20 Simple Ideas To Regain Mental Focus

Posted on August 13th, 2015 by karen

by Kim Keller

Stress and anxiety chip away at our ability to concentrate. Left unchecked, we can become paralyzed, virtually unable to move forward effectively in our lives.

Here are 20 simple actions you can take to reduce stress and regain your mental focus:

Stay Hydrated — Water transports oxygen throughout your body, which in turn boosts your energy level and helps keep you alert.
Wiggle Your Toes — Sounds silly, I know, but this great little “mindfulness” trick brings you back to the present moment and helps you refocus. Olivia Fox Cabane recommends this tip in her book, The Charisma Myth. Try it sometime.
Create a Routine — Having a regular daily schedule simplifies life, which consequently eases stress by removing a major issue (laying out your itinerary for the day) that used to occupy your brain.
Use the Mind Dump Exercise — When my brain is flooded, this exercise gives me comfort: I take 10 or 15 minutes to write down, as fast as I can, anything — anything at all — that comes to mind. It often starts with something like this: Why am I feeling SO stressed out?! I need to stop saying yes to everything! I need to get more sleep. All I want to eat is junk food! And on it goes. While the pages I create tend to be jumbled and chaotic, the exercise helps relieve anxiety and produce a sense of mental clarity.
Don’t Worry Alone — Ned Hallowell, M.D., a bestselling author and world-renowned expert on ADHD, offers these next four tips, starting with Don’t worry alone. “Worrying alone tends to become toxic,” writes Hallowell, “because in isolation we lose perspective.” The benefit of sharing your fears and concerns is that “when you worry with someone else, you usually end up problem solving, as you feel more empowered and less alone.” So find someone to talk with and get the worries out of your own head.
Get the Facts — “Toxic worry is rooted in wrong information, lack of information, or both,” explains Hallowell. Spend the time you’d normally waste on worry by getting the facts and learning what is true.
Make a Plan — Use your energy to create a plan that helps you work through the problem, instead of using your energy to worry and fret. A plan will make you feel more confident and in control of your life.
Think Happy Thoughts — “Thinking of things that promote warmth, connection, and happiness reduces the hormones associated with stress, fear, and anger that can impede concentration,” says Dr. Hallowell.
Create a To-Do List — Trying to remember all of the little tasks on your plate takes too much mental effort. Instead, keep a list of everything you need to do, no matter how big or small, all in one place. I find it useful to review the list each night and make a smaller list that separates the items based on the tasks that must be completed the following day and those that I’d like to complete but aren’t quite as urgent. A to-do list is a great way to reduce anxiety.
Use All of Your Senses — Make a point of practicing mindfulness by engaging all your senses. Next time you look at a tomato, for example, smell it, touch the skin, appreciate the shade of red, and, of course, taste it. Apply your senses whenever you can, and not just the most obvious ones. Take a moment to listen to the sounds of the day. Touch and smell things you normally just look at. Bring your entire sensory arsenal to bear on your everyday encounters.
Noise-Canceling Headphone — To protect myself from distractions, I take breaks from phones, email, texting, etc., by wearing noise-canceling headphones and listening to music without words. This amplifies my focus and helps me fixate on whatever I’m trying to accomplish.
Schedule Time to Worry — To avoid continual, uncontrolled worry, I find it helpful to allow myself actual worry time: I’m not going to worry about this tonight, I’m going to sleep, and I’ll make time in the morning to stress about this. It only works, though, if I make a pact with myself to devote equal time to reflect on what’s good in my life. This combination of scheduling worry time and giving equal attention to gratitude never fails to give me perspective. And comfort.
Work in Small Doses — Whenever I’m overwhelmed, yet eager to be productive, I set a timer for, say, 10 minutes and then force myself to concentrate fully throughout the short time frame. When the timer goes off, I take a quick break, then I start again. At the 45-minute point, I take a longer break — 15 or 20 minutes. I’ve used this timer technique for years, and I just recently found out that there is an actual name for this approach: it’s called the Pomodoro Technique.
Know Thyself — We all have times during the day when we can best focus; mine is in the morning. I try to organize my day so that anything requiring a lot of concentration and brainpower happens in the morning.
Move — Take a walk, dance, run up and down the stairs, anything to wake up your body and your brain.
Get Rest — The converse to number 15 is also true. Sleep is a great healer. For the longest time I just accepted the notion that I wasn’t a good sleeper, that I wasn’t blessed with that particular gift. But in recent years I’ve come to realize that my inability to sleep well was just another bad habit I needed to break. So I’ve put a lot of thought and effort into the subject, and that prompted a number of In Care of Dad articles. These, in particular, I found helpful. Take a look. Sleep Strategies Part One and Part Two.
Clean a Closet — Removing clutter and getting organized gives you a sense of accomplishment and a great lift. It creates momentum to tackle even larger problems.
Memorize Something — Memorization keeps your mind sharp. Try a poem or the US state capitals. If that gets too easy, learn the lines to your favorite play.
Eat Well — Reduce your sugar and caffeine intake. Eat foods that will give you natural energy, like fruits and veggies. Create a diet for yourself that reflects excellent nutritional balance.
Take Time to Meditate — I know, I know, when you’re stressed out and overwhelmed, who has time to meditate? But trust me, finding 10 minutes a day to focus on your breathing and your inner calm will set the tone for you. Just get started. First thing in the morning, before your coffee, set your timer for 10 minutes, find a quiet spot to sit comfortably, close your eyes, and take in a deep long breath. Hold it for a moment and then release a long slow exhale. To get me in the proper frame of mind, I say “in” as I take that deep breath, and then I say “out” as I let go and exhale.

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It’s All About The Meds

Posted on July 22nd, 2015 by karen

by Kim Keller

If you were to listen in on some of the conversations I’ve had with my sister Karen during the last 10 years, you might very well hear us talking about medications, and it would probably not be in a positive light.

The disenchantment began with our dad. As a result of having so many doctors contributing to his care, he was saddled with too many meds, some of which were ineffective and even unhealthy. Duplicative prescriptions, improper substances for patients over 65, too many adverse side effects, confusing dosage instructions . . . The list goes on and on.

Then, after Dad passed away, our mom’s health suffered (no surprise there, since she was Dad’s primary caregiver for so long) and the same kind of medication problems started cropping up. The lesson? Be ever vigilant about medication regimens.

Our latest concern is trying to limit the escalation of Mom’s prescription-drug intake. It’s a challenge to find the balance between the meds she really needs and the meds that are being casually prescribed to her.

In general, there are thirteen points we focus on:

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If Only There Was A Second Time Around

Posted on July 9th, 2015 by karen

by Kim Keller

As another anniversary of our father’s passing — July 16th, to be exact — approaches, my sister Karen and I find ourselves once again filled with regret for all the lessons learned, far too late in life, about how to help someone you love through serious illness.

Dad’s health issues lingered for quite some time, but during the last year of his life, he deteriorated at a tumultuous pace. It was a painful ordeal, and if it were possible to go back in time, Karen and I would do many things differently.

We would have more actively:

Insisted that our father seek better medical care earlier in his illness. The critical lesson here: sometimes you just have to travel farther for better hospitals and doctors. Dad made his choices based primarily on location, and while we often questioned the quality of his doctors and their related facilities, we weren’t comfortable pushing this point with him, until it was far too late in the game. Given what we now know, we would have kept researching hospitals in the region until we found a teaching hospital with MAGNET status. Teaching hospitals generally attract higher caliber doctors, and a MAGNET designation indicates an impressive level of quality care bestowed upon patients by the nursing staff. Naturally, there are great hospitals that are not teaching facilities, as well as many without MAGNET status, but it’s an excellent place to start.
Focused on how Dad could reduce the amount of medications he was taking. He had lots of specialists, especially as his health unraveled, and each doctor added a new prescription or two. Not enough attention was paid to the possible side effects and adverse interactions caused by combining so many medications. In fact, rather than scrutinizing the burgeoning list of drugs that were being pushed at our father, each new medical issue that cropped up heralded another new prescription. Given what we know now, we would have discussed the medication list with all the various specialists, starting with these five questions: (1) Are any of Dad’s symptoms a possible side effect of another medication? (2) What are the potential side effects of each drug? (3) Is this drug safe and/or effective for someone over 65? (4) Are there any issues to watch out for when this drug interacts with Dad’s other current medications? (5) Is there any harm in changing Dad’s diet and/or exercise regimen rather than prescribing another new medication? And to help us with our own research, we would have used MediGuard.com, which is a great tool for fleshing out medication problems.
Talked with our father about end-of-life issues. Dad already had a living will in place, so we thought we were covered in this important area, but we were wrong. We soon discovered that many common scenarios needing to be fully vetted are not handled by the average living will. For example, do you continue with aggressive treatments when they can’t cure you but can only sustain a bedridden life? Not an easy question to discuss, and we certainly never discussed this as a family, but at a certain point late in the illness, Dad was no longer able to give his input, and continuing treatments no longer held any promise of recovery. We decided to maintain the full-on treatments, but we’ve never been sure this was what Dad wanted. If we’d known back then about the critical importance of a wide-ranging end-of-life discussion, we would have used www.agingwithdignity.com. It’s an important resource that walks you through the fundamental questions that every family needs to consider.
Established ourselves as coordinators for keeping track of all communication between and amongst the various medical personnel and caregivers attending to Dad. Karen and I just didn’t understand, at least not at first, that someone had to pull together all the various pieces of information relating to Dad’s care, from medication mandates and treatment instructions to exercise orders and diet alterations. Counting on the medical teams to coordinate and communicate was not realistic. We eventually learned to keep track of everything and to communicate everything. There was nothing too big or too small. Here are some of our charts and checklists.
Created a support team around us to help us anticipate needs, develop a plan, make better decisions, and clue us in on available resources and tools. Frankly, back then we didn’t even realize we needed a support team, other than our father’s medical attendants. Dad had been sick for so long that we never would have believed we were facing his final year. Without a support team, we spent way too much time being reactive, putting out fires, floundering with decision-making. If we could do it all over again, without the pain and torture that Dad surely experienced, we would’ve reached out to people who had been down this path before. There are many places to start building a team: in-home care agencies, for example. Or local religious organizations, many of which have outreach programs, geriatric care managers, and senior centers. When we finally did build our team, we were relieved and finally confident that we were making sound decisions. We didn’t understand at that point how close we were to the end, but we were at least able to spend our time in a far more important and valuable way: loving our father and enjoying every last minute with him.

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Transforming A Life One Room At A Time

Posted on June 17th, 2015 by karen

by Karen Keller Capuciati

After one of the meetings I have every month with a group of geriatric care professionals, Kathryn, a gerontologist, was telling me what she had done for a client named “Rosie,” who had recently transitioned from post-operative rehab, where she was recovering from a femoral fracture, into an assisted-living facility.

Kathryn described how she had transformed an empty room at an ALF into a home for her client. I was touched by the lengths that Kathryn had gone to — in my opinion, she went above and beyond the normal bounds of her profession in making sure that Rosie’s new home was as nice and comfortable as it could possibly be.

“Rosie loves the outdoors,” Kathryn told me, smiling at the recollection. “So I loaded the big picture window with flowering plants, and colorful vases that I filled with flowers. Then I bought a brightly colored flowered quilt, a high-back chair and ottoman that is really cozy — in blue, Rosie’s favorite color. I also brought over some of Rosie’s artifacts and knickknacks to have in her new space.” Kathryn smiled again. “It’s a real joyful room.”

Kathryn couldn’t bring too much from Rosie’s home, but she took what she thought was important, such as the antique secretary desk. Rosie had worked her whole life as an administrative assistant, so Kathryn figured that having her desk in the new home, with lots of shelves and compartments and stacked drawers, would be a point of familiarity and comfort for Rosie. Kathryn knew intuitively that Rosie would enjoy sitting at her desk, reading the newspaper, writing cards and letters to friends. It would give the room a point of warmth and familiarity.

Kathryn was detailing the Rosie situation because of an earlier group discussion about how long it often takes new residents to get acclimated to an unknown facility. It’s no surprise really — imagine being moved into a building full of strangers, sometimes against your wishes, sleeping in an unfamiliar bed, eating in a dining room while surrounded by faces you’ve never seen, being given a routine that’s wholly different from the one you’ve been living for years. It feels like the comfort of home has been ripped away from you.

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Five Simple Strategies For Living With Dementia

Posted on June 10th, 2015 by karen

by Kim Keller

Sometimes it’s the simplest action that has the biggest impact. That’s why I love these five “good ideas” to help anyone who’s caring for a loved one with dementia. Take a look.

The Magic of Music — Music, as we’ve come to learn, has a powerful and transformative effect on those with dementia. Check out the movie trailer from this must-see documentary, Alive Inside, and you’ll see what I mean. It’s relatively easy for you to try out — just put together a playlist of your loved one’s favorite music and load the songs onto an iPod shuffle (or any other device with simple controls). To get the biggest benefit, the music should be listened to with earplugs or a headset, in order to minimize potential distractions and allow your loved one to be totally engaged by the music. By the way, Alive Inside is now available for purchase on DVD or iTunes.
Create a Routine — Have a routine for daily activities like eating, exercising, bathing, sleeping. The discipline of a routine tends to provide calm and focus, and no energy is wasted on superfluous decision-making.
Calling Cards — One of our contributors, Colleen Lanier, gave us this great suggestion: create calling cards for your loved one. Handing a stranger a card that alerts him or her to your loved one’s impairment can discreetly reduce the potential for awkward and/or misunderstood moments.
Sundowning Strategies — “Sundowning” is a psychological syndrome that entails increased confusion and restlessness among patients with some form of dementia, particularly Alzheimer’s. The term itself refers to the most common timing of the confusion. Finding simple activities, whether it’s helping with household chores or playing a board game, can help to ease problematic behavior. Dr. Paul Raia, a regular contributor to In Care of Dad, provides some important insight into sundowning here.
Safe Return — The Alzheimer’s Association has collaborated with MedicAlert to create a nationwide emergency response program called “MedicAlert® + Alzheimer’s Association Safe Return®” which provides a bracelet or pendant for your loved one to wear at all times. The jewelry is inscribed with the words “memory impaired” and an emergency hotline number that operates 24/7, as well as any critical medical information. So if a loved one goes missing, you can call the emergency number and immediately set in motion a search by law enforcement and personnel from the local Alzheimer’s Association. The emergency hotline operators also have full access to all pertinent medical information. The registration is simple and can be done online. The cost, as of this writing, is $55 for the first year, with a $35 renewal fee each year thereafter, plus a $7 shipping fee for the bracelet or pendant. Another consideration is “Comfort Zone,” a GPS tracking service linked to your family’s home computer that monitors your loved one’s whereabouts at all times. The information can also be delivered through text messages. This service is $42.99 per month, with a $45 activation fee. This monthly plan also comes with the MedicAlert + Alzheimer’s Association Safe Return package mentioned above. There may be an additional fee for shipping and handling of the jewelry. Here’s more information from the Alzheimer’s Association.

Kim Keller is the Co-Founder of In Care of Dad. She lives and works in New York City.

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Game Change

Posted on May 20th, 2015 by kim

by Kim Keller

Mary Clare and Marti remember how much their mom Alice loved to play games. Card games, board games, games of strategy, games of luck, Alice was always an eager participant.

The two daughters remember their mom playing bridge for years and years. Indeed, Alice was a member of two different bridge clubs, one with her friends and another with the ladies from her church, and each group would meet one night a month in each others’ homes, pair off into partners and then bid, pass, double and redouble.

Alice enjoyed playing bridge so much that it must have been terribly painful for her to realize she could no longer manage the tricky game. Alice, you see, had Alzheimer’s disease. She was 82 years old when she was diagnosed. Naturally, and yet horribly, as Alice’s disease progressed, it took away pieces of her life, bit by bit, and left her with just a shred of her former cognitive abilities.

Back when it was still in the early stages, Mary Clare and Marti asked their mom why she had stopped playing bridge, and Alice explained that the game now frustrated her. Her partners, she fretted, were seriously disadvantaged by teaming up with her because she was having trouble remembering what cards had been played.

If you can conceive how hard it is for a 40-year-old athlete to hang up his spikes, try to imagine how it feels for an 80-year-old to play her last hand of bridge.

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To Drive Or Not To Drive: Help Is Available

Posted on May 14th, 2015 by karen

by Kim Keller

In most of America, people are still very much reliant on automobiles to get around. Not so much in urban areas, where public transportation is highly developed, but everywhere else, driving is pretty much a cultural requirement. So, one of the hardest adjustments my mom has had to make is not being able to drive, even temporarily. She’s had some health challenges during the last few years that have impacted her ability to drive safely, so my sister Karen and I had to find alternate transportation and a pathway for Mom to return to driving her own car.

Here’s what we did:

After she had a stroke in 2009, there was a period when Mom’s cognitive ability was a bit shaky. She had trouble reading some street signs, and her decision-making capacity was not yet ready for the split-second requirements of Florida traffic. Her doctors told us it was a temporary situation, and Mom was certainly eager to get back behind the wheel, but Karen and I were concerned that it was too soon. So, after speaking with one of Mom’s doctors, we contacted a nearby rehabilitation center that had a program for evaluating the readiness of drivers who have incurred a physical and/or mental impairment as a result of injury, illness or normal aging.

A specialized Occupational Therapist conducted the testing. The therapist evaluated Mom’s ability to drive by testing her vision, her physical capabilities and her overall capacity to make quick judgment calls. The sensory testing was followed by an actual driving assessment.

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Water, Water, Everywhere: Preventing Dehydration

Posted on May 6th, 2015 by kim

by Kim Keller

I never fully appreciated how important drinking water was until my dad needed to be hospitalized — twice! — as a result of severe dehydration. He first complained about feeling extremely tired, and then he suddenly became completely confused, seemingly out of the blue. It scared us! Dad was so weak and disoriented that we needed to call an ambulance to get him safely to the hospital.

And as it turned out, the fuss was all about water.

It seems so simple. Water. Yet, severe dehydration is a serious health concern for aging adults. Medications can be dehydrating. The ability to signal thirst doesn’t work quite as well anymore. The ability to store fluids diminishes. Those with dementia can no longer keep track of their water intake. And, for many, the dismay of incontinence makes all fluid intake extremely undesirable.

My sister Karen and I became relentless reminders with our dad, and now with our mom, to drink more water! Talking with friends, we’ve discovered that we aren’t alone. Many of them have experience with this issue as well.

So we asked for some of their tips, and here’s what they told us:

“I am always trying to get my mom to drink more water. Part of the problem is not knowing how much she drank. I always suggest that she put water in a quart bottle and I tell her she needs 2 bottles a day. That way she always knows how much she had.”

~ Mindy, art restorer, Weston, CT

“Most older adults, I have found, if they drink water at all, handle it better in small doses — meaning a small glass, but fairly consistently throughout the day. Encourage drinking a full (small) glass when taking meds, which is usually at least twice daily. I encourage clients to drink about half the small glass before taking the meds, so they go down easier. I try to get them to also drink a full glass (even if it’s small) with every meal. Make it a routine.

“I think water can be boring and uninteresting for many older adults, so we put it “on the rocks,” or we add a splash of OJ, grapefruit juice, cranberry, etc., to mix things up. (Be sure to check if there are any issues with medication interactions here.) We’ve even added a maraschino cherry for fun.”

~ Kathy, a gerontologist and eldercare manager, Hartford, CT

“I recently bought something called a citrus zinger water bottle. It has a juicer on the bottom for lemons, limes and oranges but can also be used for fruit of all kinds. It flavors the water, which sometimes is what’s missing for people: raspberries and lime, blackberries and lemon, melon and mint, etc.”

~ Karla, Darien, CT

“What is their favorite drink? Coffee? Then put liquids in their favorite coffee cup and make sure it’s hot. Whiskey? Then pour apple juice in a favorite whiskey bottle and warm it up in the microwave. Juice? Then pour water in a red-pebbled glass so that it looks like juice. Martini? Pour water in a martini glass and add olives. When it looks like their favorite drink, they are more likely to drink it.”

~ Jolene Brackey, author of Creating Moments of Joy for the Person with Alzheimer’s or Dementia.

“In the last couple of years of my father’s life, he would get so dehydrated that he’d have these episodes. He’d lose contact with reality, start calling out, and become incoherent or delusional. It was always a big emergency, involving ambulances and rushed visits to the hospital. One time they almost had to turn a plane around on the way to Florida. We did everything we could think of to entice him to drink. There was always a water bottle, fruit juice, his favorite drinks like Cel-Ray soda (we had to get it from NYC; soda that actually tastes like celery), non-alcoholic beer or soup at hand. It seemed like we asked him to take a sip of water at the beginning of every other sentence.

“The only time he requested water was one time that he came out of a coma. He was “nothing by mouth” at the time. He asked me for water, and it was quite the moment because we had been told he was not going to wake up, that he was going to die that night. So I had to refuse him. His eyes flew open. He thought it was so funny after all the times that I had asked him to take a drink. He said, ‘WHY? WHY??’ and then asked for the nurse. When she came, he said, ‘Tell her what you just told me.’ I repeated my refusal about the water. The nurse confirmed the medical orders and then went and called his doctor at 1 a.m. to have the orders reversed. When she came back in, she asked him what he wanted. ‘I want what I can’t have,’ he said, meaning Scotch. But he finally agreed to some water.

“I tell this story because I would have to say that, while we were very committed and resourceful in taking care of my dad, I always felt embarrassed when he had these episodes, as if I hadn’t been taking good enough care of him, as if it should have been so easy to simply give him water. So that would be my first piece of advice: to hope that people won’t feel embarrassed when this happens. The other things we learned to look for was his skin tenting or his tongue being wrinkled, but we really could have used a better way to anticipate these episodes.

“It would have been better if we could have made an arrangement to bring him in for an IV drip or, better yet, to have it available at the house, rather than wait until we had to call an ambulance because, by that point, it was very difficult to move my dad around. There were many times, taking care of Dad, that I felt like simple remedies were not available to us. These things would have made our lives easier at such a difficult time, but there was no place for simple solutions in a system that had a rule and a procedure for everything.”

~Grace, photographer, Block Island, RI

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The Flu. Who Knew? A Daughter’s Journal

Posted on April 22nd, 2015 by karen

Arthur Whitman takes a sip.

by Beth Whitman

Dad got the flu this winter. Funny thing was, it didn’t look like the flu. I thought he was just more tired than usual, or that maybe he had the mid-winter blues.

What I discovered, though, is that the flu looks and acts differently in older folks than it does in the rest of us. Dad showed none of the symptoms that we normally associate with influenza, at least not until AFTER he was admitted to the hospital.

Here is what his flu looked like: For three days, I noticed Dad getting weaker and weaker. He started out just lying in bed all day. He had no interest in activity, and he didn’t seem to have much of an appetite. To get him up and moving around, which seemed like a good idea, I had to walk with him the 20 steps out to his living-room chair. He didn’t have the energy to button or even zip up his pants. I asked him if he was okay.

“Yes” was all he said, but it wasn’t convincing.

He soon became incontinent because he didn’t have the energy to get to the bathroom in time, and then not even the energy to stand up and pee in his portable urinal. He had also lost all interest in consuming fluids.

By the third evening, when it was time for him to head into his bedroom, I went over to help him stand up. He was slouched in his big stuffed chair by the window, and seemed unusually extra-tired. I asked him if he wanted to be wheeled into the bedroom. He nodded, and then coughed a little. So I brought a wheelchair over to where he was sitting, and put my arm around his back and gave him my arm to lean on, but he was just dead weight. He couldn’t stand up — even with my help.

I called my neighbor, Steve, and asked him to come over to help me transfer my father into his wheelchair. The two of us were able, with considerable difficulty, to move him into the chair.

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A Roadmap For Finding Excellent In-Home Help

Posted on April 15th, 2015 by karen

by Karen Keller Capuciati

For most of us, the prospect of hiring in-home help can be overwhelming. I remember the first time our parents needed in-home care, back in 2006. Dad was very ill and required round-the-clock assistance. We needed someone to help out at night so that Mom could get some sleep.

We had no idea where to even look for help, let alone how to find the right person. There were so many variables to resolve, like convincing Mom that she needed help in the first place, and then deciding whether to hire from a licensed agency or find an independent contractor, like a friend-of-a-friend from church, for example (referred to as “the grey market”). Most of all, we weren’t sure how to find someone our parents would feel comfortable having in their house at night, or how to make sure that person would be reputable and qualified. I remember thinking there were endless problems to overcome.

Eldercare professionals, like the ones I meet with every month, often help their clients find the best in-home-care candidates. They do some interviewing and checking of references, qualifications and backgrounds, and then provide a couple of recommendations. And after years of doing this, and observing the results in various situations, these professionals have learned what works, what doesn’t and which pitfalls to avoid.

So I asked my group to give us some tips on finding excellent in-home help. Here is some of the solid advice they offered:

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