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http://helpguide.org/elder/alzheimers_disease_dementia_caring_final_stage.htm
Late Stage and End-of-life Alzheimer’s Care
Caregiving in the Final Stages of Alzheimer’s Disease
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In the final stages of Alzheimer’s disease, care priorities shift and the continuum of loss and release proceeds. The complex and often disorderly progression of this terminal disease now requires complete care 24 hours a day, 7 days a week.
Even with years of experience, caregivers often find the last stages of Alzheimer’s disease uniquely challenging. Simple acts of daily care contrast with complex end-of-life decisions and profound bereavement. Learning to anticipate, remember, and reconnect can ease the journey through care and grief towards meaning, healing and wholeness.
In This Article:
- Understanding late stage needs
- Care and placement options
- Family planning
- Helping a loved one
- Coping with grief and loss
- Moving on after final stage care
- Related links
Understanding late stage Alzheimer’s care needs
In the later phases of Alzheimer ’s disease (AD), it becomes evident that in spite of the best care, attention, and treatment, your loved one is approaching the end of life. At this stage, a patient can no longer communicate directly, is totally dependent for all personal care, and is generally confined to bed. Unable to recognize once cherished people and objects, or to verbally express basic requirements, the person with Alzheimer’s completely depends on sensitive caregivers to advocate, connect, and attend to her needs.
Many caregivers finally acknowledge their own needs for significant help. This period may last from a matter of months to three years, and calls for revised strategies, tough decisions, and an expanded team. Understanding and anticipating these changes provides a framework from which to proceed.
Patient and caregiver needs in late stage Alzheimer’s care
- Practical care and assistance. Your loved one can no longer talk, sit, walk, eat, or make sense of the world. Routine activities, including bathing, feeding, toileting, dressing, and turning require total support and increased physical strength. Tasks are clear and prioritized, and can be supported by personal care assistants or physician-ordered nursing services.
- Comfort and dignity. Although cognitive and memory functions are depleted, the capacity to feel frightened or at peace, loved or lonely, and sad or secure remains. Regardless of location, the most helpful interventions are those which ease discomfort and provide meaningful connections.
- Caregiving support. The final stage care team might include home health agents, nursing home personnel, legal or financial advisors, hospice providers, and palliative care physicians. Working in advance with compassionate professionals to navigate systems, explore benefits, and weigh deeply-felt options can be extremely beneficial.
- Grief support. Anticipating your loved one’s death can produce reactions from relief to sadness to feeling numb. Experiencing these profound life changes can ease your loved one’s final journey and support your ultimate recovery and happiness. Consulting bereavement specialists or spiritual advisors before your loved one’s death can help you prepare for the coming loss.
Care and placement options in final stage Alzheimer’s disease
Advanced illnesses, physical safety needs, and the 24-hour demands of final stage caring often prompt additional in-home interventions or out-of-home placement. Although many caregivers want to keep their loved ones at home, this requires stamina, space, and considerable support from others.
Although there are no right or wrong answers, multiple changes can be especially difficult for a patient with advanced dementia. Adjustment to placement is easier before the end stage. Care and placement decisions should reflect the patient’s current needs, plans for her eventual death, and the caregiver’s health, financial, and emotional needs.
Fortunately, many resources are available to help you with placement and service options. See the related links section below, and contact your area Alzheimer’s Association for a care consultation.
Can you take care of the person with Alzheimer’s disease at home?
- Is qualified, dependable support available to insure 24 hour care?
- Will your home accommodate a hospital bed, wheelchair, and bedside commode?
- Are transportation services available to meet daily needs and emergencies?
- Is professional medical help accessible for routine and emergency care?
- Are you able to lift, turn, and move your loved one?
- Can you meet your other responsibilities and your loved one’s needs?
- Are you emotionally prepared to care for your bed-ridden loved one?
(Source: Adapted from The Loss of Self: A Family Resource for the Care of Alzheimer's Disease, Donna Cohen, PhD, and Carl Eisdorfer, PhD).
To evaluate other care and placement options, see Helpguide’s Choosing Senior Housing and Residential Care.
Family planning: decisions in late stage Alzheimer’s care
When patients with Alzheimer ’s disease (AD) reach the final stages, their caregivers have grieved physical, cognitive, and behavioral regression for years. Many struggle to make difficult treatment, placement, and intervention choices through a prism of continuous and profound loss. As your loved one’s serious decline becomes more evident, the skills and understanding cultured during caregiving can keep you engaged and committed.
End stage changes are often more difficult for family members than patients. Intricate and highly personal decisions can shift focus from comfort and dignity to unresolved personal or relationship issues. Following are tips for making patient-centered determinations in this last period of life:
· Prepare early. The AD journey is eased considerably when placement, treatment, and end-of-life conversations are held in the first stages. Consider using the Five Wishes process to guide and formalize your discussion. Seek financial and legal advice while your loved one can participate. Consider hospice services, spiritual practices, and memorial traditions before they are needed. When caretakers simply implement their loved ones’ preferences, they are free to emphasize care and compassion.
· Focus on values. If your loved one did not prepare a living will or advanced directives while competent to do so, act on what you know or feel his wishes are. Make a list of conversations and events that illustrate his views. To the extent possible, consider treatment, placement, and decisions about dying from his vantage point.
· Address family conflicts. Family members vary in their capacities for emotional openness and expression. When stress and grief are heightened by a loved one’s deterioration and withdrawal, conflict may result. If you are unable to agree on living arrangements, medical treatment, or end-of-life directives, ask a trained doctor, social worker, or hospice specialist for mediation assistance. Prolonged disagreement can impact your ability to grieve and hamper your well-being.
· Communicate with family members. Choosing a primary decision maker and a communicator to manage information facilitates family involvement and support. Even when families know their loved one’s wishes, implementing decisions for or against sustaining or life-prolonging treatments requires communication and coordination.
If children are involved, make efforts to include them. Children need honest, developmentally appropriate information about your loved one’s condition and any changes they perceive in you. They can be deeply affected by situations they don’t understand, and may benefit from drawing pictures or using puppets to simulate feelings, and hearing stories that explain events in terms they can grasp.
Helping a loved one in the final stages of Alzheimer’s disease
Insuring a loved one’s final years, months, or days are as good as they can be is not just a series of resource and care choices. Learning to live through grief, celebrate your accomplishments, and honor your loved one’s life will shape your emotions and determine your tasks.
Passage through the final stage of Alzheimer’s disease is affected by several factors: economics, family and friends, care options, and caregiver resilience. Ideally, the patient’s pain is well controlled, interactions acknowledge her remaining emotional presence, caregivers and other family members are supported, and there is time for a calm, peaceful goodbye. Your tasks may include the following:
Partnering to manage pain
Even in the last stages, patients with Alzheimer’s disease communicate discomfort and pain. Pain and suffering cannot be totally eliminated, but you can help make them tolerable.
Managing pain and discomfort requires daily monitoring and reassessment of subtle nonverbal signals. Especially when a dramatic decline in functioning occurs, families may choose to discontinue other medical interventions and focus on palliative care for the pain and symptoms associated with dying. With adequate help, this care can be provided at home.
Subtle, behavioral changes can signal unmet needs. Communicating written observations, times, and events to your medical team will provide valuable clues about your loved one’s pain status. The soothing properties of touch, massage, music, fragrance, and a loving voice can also reduce pain. Be open to trying different approaches and observe your loved one’s reactions.
Connecting and loving
Sharing human kindness through the final stages of Alzheimer’s disease takes many forms. Even when patients cannot speak or smile, their emotional memories remain.
Staying calm and attentive will create a soothing atmosphere and communicating through sensory experiences such as touch or singing can be reassuring to your loved one. Contacts with pets or trained therapy animals bring pleasure and ease transitions for even the most frail. Surrounding a loved one with pictures and mementos, reading aloud from treasured books, playing music, giving long, gentle strokes, reminiscing, and recalling life stories promote dignity and comfort all the way through life’s final moments.
Caring for yourself
As impossible as it may seem, taking care of yourself during your loved one’s final stages is critically important. Research shows spousal caregivers are more likely to experience despair while adult children find fulfillment through their caregiving roles. In any case, it is important to learn how to adjust, feel whole again, and move on
Coping with grief and loss as an Alzheimer’s caregiver
Ironically, the extended Alzheimer’s journey gives families the gift of preparing for, and finding meaning in their loved one’s end of life. When death is slow and gradual, many caregivers are able to prepare for its intangible aspects, and to support their loved ones through the unknown. Even with years of grief, others find themselves unprepared and surprised when death is imminent.
Talking with family and friends, consulting hospice services, bereavement experts, and spiritual advisors can help you work through these feelings and focus on your loved one. Palliative care specialists and trained volunteers assist not only on the dying person, but also caregivers and family members.
The end-of-life period, when body systems are shutting down and death is eminent generally lasts from a matter of days to a couple of weeks. Some Alzheimer’s patients die gently and tranquilly, while others seem to fight the inevitable. Reassuring your loved one it is okay to die can help both of you through this process. Decisions about hydration, breathing support, and other interventions should be consistent with your loved one’s wishes and advanced directives.
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Working Through Grief
Caregiving is a demanding, difficult job and no one is equipped to do it alone. Feelings of gloom, anger and despair may be reactions to loss. Recognizing grief and its potential for healing can help you through the final stages of Alzheimer’s care.
Read: Coping With Grief and Loss
Moving on after final stage Alzheimer’s care
From the moment of a loved one’s Alzheimer’s diagnosis, a caregiver’s life is never the same. It can, however, be happy, fulfilling, and healthy again. Replacing lost relationships, using your experience to help others, and gaining new perspective will help your return to normalcy.
Reconnect
- Join a caretakers’ bereavement support group. Being with others who know your situation, understand your emotions, and feel your suffering is good medicine.
- Enroll in an adult education class. Find a yoga, Tai-Chi, or Salsa class. Acquiring new skills and staying physically active will promote healing.
- Try a new community. Join a book club, volunteer, or start a neighborhood dine-around group. Your needs to enjoy, laugh, and connect continue after your loved one is gone.
Use your loss
- Create lasting tributes to your loved one. Consider memorial sites, scholarships, plaques, scrapbooks, quilts, art forms, benches and charitable contributions to honor her memory.
- Write a story, create a poem, make a tape. Share your loved one’s unique story with family members and other caregivers.
- Become a mentor. Contact your local Alzheimer’s Association and ask them to pair you with a brand new caregiver. Use your knowledge to help another.
Gain perspective
- Write your caregiver’s resume. List what you have learned and accomplished. By celebrating your considerable skills, you may discover a new avenue for work or expression.
- Keep a journal. Confront your loneliness and allow yourself to see your progress through the healing process.
- Talk to a therapist or grief counselor. Giving yourself permission to find new meaning and relationships can be difficult, but you have earned health and happiness.
Your acts of care and connection sustained your loved one through a long and difficult passage. Taking active steps to explore dreams, nurture yourself, and find creative paths to vitality are now your most important tasks. Sharing what you have learned, cultivating happiness, and finding new meaning build a loving finale to your caregiving journey.
Related Articles
Support for Alzheimer's and Dementia Caregivers
What the Caregiver Needs
Coping with Grief and Loss
A Guide to Grieving and Bereavement
More Helpguide articles:
- Dementia and Alzheimer’s Care: Tips, Activities, and Long-Term Care Options
- Preventing Caregiver Burnout: Tips and Support for Family Caregivers
- Stress Management: How to Reduce, Prevent, and Cope with Stress
- Alzheimer’s Behavior Management: Managing Common Symptoms and Problems
Need More Help?
![Description: Bring Your Life Into Balance]()
Bring Your Life Into Balance: Emotional Skills Toolkit
Feeling overwhelmed by stress and the demands of the caregiving experience? This toolkit can help you learn how to regain your emotional balance. Go to Toolkit »
Related links for Late Stage and End-Of-Life Alzheimer’s Care
Tips for care and understanding
Alzheimer's Playbook: Practical tips and strategies through all stages of Alzheimer’s care (Alzheimer’s Association)
Alzheimer's Poetry Project: Staying connected to your loved one during late stage Alzheimer’s care (Alzheimer’s Poetry Project)
Anticipating Needs: End-of-life needs of people with Alzheimer’s disease (Mayo Clinic)
Caring for A Loved One With Advanced Dementia: Manual on issues and treatment of final stage Alzheimer’s care (Hospice of Michigan).
End-Of-Life: What to expect before, during and after the dying process (Hospice Foundation of America)
Final Stage and End-of-Life Care: Discusses care strategies and after-death support for Alzheimer’s caregivers (Alzheimer Society)
Late Stage Care: Reviews issues and provides suggestions for late stage Alzheimer’s caregiving (Alzheimer’s Association)
Providing Care: Late stage comfort in Alzheimer’s care (National Institute on Aging).
Grief and loss
Grief and Loss: Normal grief and loss during Alzheimer’s caregiving (About.com)
Grieving for The Living: Coping with anticipatory grief in Alzheimer’s disease (Caring.com)
Hospice Admissions Guidelines: Admission and recertification in end-stage Alzheimer’s disease (AlzOnline Caregiver Support)
Planning and legal considerations
End-Of-Life Planning: Living wills and advanced directives (Compassion & Choices)
Five Wishes (PDF): Living will form for directing care and intervention in the final stages of life (Aging With Dignity)
Legal and Financial Planning: Legal and financial considerations with Alzheimer’s disease (Alzheimer’s Disease Education and Referral)
http://helpguide.org/elder/caring_for_caregivers.htm
Preventing Caregiver Burnout
Tips and Support for Family Caregivers
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Outside the world of paid work, the people most prone to burnout are caregivers – people who devote themselves to the unpaid care of chronically ill or disabled family members. The demands of caregiving can be overwhelming, especially if you feel you have little control over the situation or that you’re in over your head.
If you let the stress of caregiving progress to burnout, it can damage both your physical and mental health. So if you’re caring for a family member, it’s essential that you get the support you need. The good news is that you’re not alone. Help for caregivers is available.
In This Article:
- Family caregivers: what you should know
- Signs of caregiver burnout
- Get the help you need
- Seek emotional support
- Taking care of yourself while caregiving
- References and resources
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Family caregivers: What you should know about burnout
Providing care for a family member in need is a centuries-old act of kindness, love, and loyalty. And as life expectancies increase and medical treatments advance, more and more of us will participate in the caregiving process, either as the caregiver, the recipient of care, or possibly both.
Unfortunately, caregiving can take a heavy toll if you don’t get adequate support. Caregiving involves many stressors: changes in the family dynamic, household disruption, financial pressure, and the sheer amount of work involved. The rewards of caregiving – if they come at all – are intangible and far off, and often there is no hope for a happy outcome.
As the stress piles up, frustration and despair take hold and burnout becomes a very real danger. But you can prevent caregiver burnout by following a few essential guidelines:
- Learn as much as you can about your family member’s illness and about how to be a caregiver as you can. The more you know, the more effective you’ll be, and the better you’ll feel about your efforts.
- Know your limits. Be realistic about how much of your time and yourself you can give. Set clear limits, and communicate those limits to doctors, family members, and other people involved.
- Accept your feelings. Caregiving can trigger a host of difficult emotions, including anger, fear, resentment, guilt, helplessness, and grief. As long as you don’t compromise the well-being of the care receiver, allow yourself to feel what you feel.
- Confide in others. Talk to people about what you feel; don’t keep your emotions bottled up. Caregiver support groups are invaluable, but trusted friends and family members can help too. You may also benefit from seeing a therapist or counselor.
10 Tips for Family Caregivers
- Caregiving is a job and respite is your earned right. Reward yourself with respite breaks often.
- Watch out for signs of depression, and don’t delay in getting professional help when you need it.
- When people offer to help, accept the offer and suggest specific things that they can do.
- Educate yourself about your loved one’s condition and how to communicate effectively with doctors.
- There’s a difference between caring and doing. Be open to technologies and ideas that promote your loved one’s independence.
- Trust your instincts. Most of the time they’ll lead you in the right direction.
- Caregivers often do a lot of lifting, pushing, and pulling. Be good to your back.
- Grieve for your losses, and then allow yourself to dream new dreams.
- Seek support from other caregivers. There is great strength in knowing you are not alone.
- Stand up for your rights as a caregiver and a citizen.
Source: National Family Caregiver's Association
Warning signs of caregiver burnout
Once you burn out, caregiving is no longer a healthy option for either you or the person you’re caring for. So it’s important to watch for the warning signs of caregiver burnout and take action right away when you recognize the problem.
Common warning signs of caregiver burnout:
- You have much less energy than you used to
- It seems like you catch every cold or flu that’s going around
- You’re constantly exhausted, even after sleeping or taking a break
- You neglect your own needs, either because you’re too busy or you don’t care anymore
- Your life revolves around caregiving, but it gives you little satisfaction
- You have trouble relaxing, even when help is available
- You’re increasingly impatient and irritable with the person you’re caring for
- You feel overwhelmed, helpless, and hopeless
Preventing caregiver burnout tip 1: Get the help you need
Find caregiver services in your area
Explore the Family Caregiver Alliance’s Family Care Navigator, a state-by-state resource intended to help you locate services for family caregivers and resources for older or disabled adults.
The first strategy for preventing caregiver burnout is: Don’t try to do it all alone. Taking on all of the responsibilities of caregiving without regular breaks or assistance is a surefire recipe for burnout.
Ask for help when you need it. Enlist friends and family who live near you to run errands, bring a hot meal, or “baby-sit” the care receiver so you can take a well-deserved break.
Also, there are services to help caregivers in most communities, and the cost is often based on ability to pay or covered by the care receiver’s insurance. Services that may be available in your community include adult day care centers, home health aides, home-delivered meals, respite care, transportation services, and skilled nursing.
- Caregiver services in your community – Call your local Area Agency on Aging, senior center, senior services organization, county information and referral service, university gerontology department, family service, or hospital social work unit for contact suggestions.
- Caregiver support for veterans – If your care recipient is a Veteran, home health care coverage, financial support, nursing home care, and adult day care benefits may be available. Some Veterans Administration programs are free, while others require co-payments, depending upon the veteran’s status, income, and other criteria.
- Your family member’s affiliations – Fraternal organizations such as the Elks, Eagles, or Moose lodges may offer some assistance if your family member is a longtime dues-paying member. This help may take the form of phone check-ins, home visits, or transportation.
- Community transportation services – Many community transportation services are free for your care recipient, while others may have a nominal fee or ask for a donation. Your local Area Agency on Aging (AAA) can help you locate transportation to and from adult day care, senior centers, shopping malls, and doctor's appointments.
- Telephone check-ins – Telephone reassurance provides prescheduled calls to homebound older adults to reduce their isolation and monitor their well-being. Check with your local AAA, religious groups, senior centers, and other public or nonprofit organizations.
- Adult day care – If your loved one is well enough, consider the possibility of adult day care. An adult day care center can provide you with needed breaks during the day or week, and your loved one with some valuable diversions and activities.
For more information, see Adult Day Care Centers: A Guide to Options and Selecting the Best Center for Your Needs.
Preventing caregiver burnout tip 2: Seek emotional support
Pablo Casals, the world-renowned cellist, said, “The capacity to care is the thing that gives life its deepest significance and meaning.” Although caregivers are often isolated from others, it’s essential that you receive the emotional support you need, so you don’t lose that capacity.
Share what you’re going through with at least one other person. Turn to a trusted friend or family member, join a support group, or make an appointment with a counselor or therapist. You can also draw strength from your faith. A congregation in a church or synagogue can provide the encouragement you need to feel good about your caregiving role, and may also be able to provide a break from time to time.
The value of caregiver support groups
Remember that old adage, "trouble shared is trouble halved"? A caregiver support group is one way to share your troubles. Seek out people who are going through the same experiences that you are living each day. If you can't leave the house, many Internet services are available.
In most support groups, you'll talk about your problems and listen to others talk; you'll not only get help, but you'll be able to help others, too. Most important, you'll find out that you're not alone.You’ll feel better knowing that other people are in the same situation, and their knowledge can be invaluable, especially if they’re dealing with the same illness you are.
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Types of Caregiver Support Groups |
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Community support groups for caregivers:
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Internet support groups for caregivers:
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To find a community support group, check the yellow pages, ask your doctor or hospital, or call a local organization that deals with the health problem you would like to address in a support group. To find an Internet support group, visit the website of an organization dedicated to the problem or do a web search on the name of the problem.
Preventing caregiver burnout tip 2: Take care of yourself
When you are a caregiver, finding time to nurture yourself might seem impossible. But you owe it to yourself to find the time. Without it, you may not have the mental or physical strength to deal with all of the stress you experience as a caregiver. Give yourself permission to rest and to do things that you enjoy on a daily basis. You will be a better caregiver for it.
Tips for taking care of yourself:
- Incorporate activities that give you pleasure even when you don't really feel like it. Listen to music, work in the garden, engage in a hobby…whatever it is that you enjoy.
- Pamper yourself. Take a warm bath and light candles. Find some time for a manicure or a massage.
- Eat balanced meals to nurture your body. Find time to exercise even if it's a short walk everyday. Do the best you can to sleep at least 7 hours a night.
- Laughter really is the best medicine. Buy a light-hearted book or rent a comedy. Whenever you can, try to find some humor in everyday situations.
- Keep a journal. Write down your thoughts and feelings. This helps provide perspective on your situation and serves as an important release for your emotions.
- Arrange a telephone contact with a family member, a friend, or a volunteer from a church or senior center so that someone calls each day to be sure everything is all right. This person can help by contacting other family members with status updates or to let them know if you need anything.
- Try to set a time for afternoons or evenings out. Seek out friends and family to help you so that you can have some time away from the home. If it is difficult to leave, invite friends and family over to visit with you. Share some tea or coffee. It is important that you interact with others.
![Description: Preventing Burnout: Symptoms, Causes and Coping Strategies]()
Preventing Burnout: Symptoms, Causes and Coping Strategies
Comprehensive Helpguide article focusing on work-related burnout and what you can do to recover, To learn more about stress management strategies, social support, and self-care, see
Preventing Burnout: Signs, Symptoms, Causes, and Coping Strategies
Related Articles
Respite Care
Finding and Choosing Respite Care Services and Providers
Stress Management
How to Reduce, Prevent, and Cope with Stress
More Helpguide articles:
- Support for Alzheimer's and Dementia Caregivers: What the Caregiver Needs
- Home Care Services for Seniors: Services to Help you Stay at Home
- Adult Day Care Centers: Finding the Best Center for Your Needs
Need More Help?
![Description: Bring Your Life Into Balance]()
Bring Your Life Into Balance: Emotional Skills Toolkit
Feeling overwhelmed by stress and the demands of the caregiving experience? This toolkit can help you learn how to regain your emotional balance. Go to Toolkit »
Related links for preventing caregiver burnout
Preventing family caregiver burnout
The Caregiver Manual – Comprehensive resource for caregivers, including articles on how to decrease stress, find support, and balance your time. (Strength for Caring)
Family Caregiving 101 - Offers advice, information, and support for caregivers. Includes a directory of resources, including financial advisors, support groups, and elder care organizations. (National Family Caregivers Association and the National Alliance for Caregiving)
Recognizing and Coping With Caregiver Burnout – This page, linked to a page on “Getting help to prevent burnout,” is on a terrific, comprehensive Canadian site about caregiving. (Peel Public Health)
Preventing Caregiver Burnout – Part of a handbook and resource guide for caregivers in Florida. Examines the signs of caregiver burnout and how to handle it. Includes tips for caregivers who are themselves challenged by age or infirmity. (Area Agency on Aging of Pasco-Pinellas)
Tips and support for family caregivers
Information Library – 100 fact sheets and publications on numerous caregiving issues. (Family Caregiver Alliance)
Tips for Caregivers – Provides information to help caregivers prevent burn-out and relieve the stresses of caregiving. (National Family Alliance)
Tips for Family Caregivers – Ten important tips for caregivers. (National Family Caregivers Association)
Online Guide to Caregiving – A comprehensive collection of articles and tools to assist caregivers. (AARP Magazine)
Advice for Caregivers / Terminal Illnesses - Contains articles that present advice for caregivers faced with terminal illness patients. (Terminal Illness)
http://helpguide.org/toolkit/emotional_health.htm
Bring Your Life Into Balance
HELPGUIDE'S STRESS-BUSTING, MOOD-BOOSTING TOOLKIT FOR BUILDING EMOTIONAL SKILLS
At Helpguide, we often hear from people who feel overwhelmed by stress, family and relationship problems, health challenges, and painful emotions. They’ve read our articles and learned that they can do things to help themselves feel better, but they just can’t seem to follow through.
It’s all too easy to become discouraged when you’re stuck. The problem is not willpower—all the willpower in the world won’t matter if you don’t know how to manage stress and balance your emotions.
The good news: you can learn these skills, no matter your age or the obstacles you face. We have built a special toolkit called Bringing Your Life Into Balance that teaches these emotional skills.
Skill building, like any learning, takes time and effort. Self-defeating habits get grooved in the brain and it takes practice to create new grooves. This toolkit guides you every step of the way and helps keep you motivated as you bring your life back into balance.
Jeanne Segal, Ph.D. - Helpguide Co-founder & Editorial Director
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· Start here: Step-By-Step Guide to the Toolkit · Video 2: Roadblocks to Awareness (2:54) · Video 5: Harness Your Emotions (3:31) |
· Introductory Article: Bring Your Life Into Balance · Video 3: Quick Stress Relief (4:11) · Video 6. Unexpected Rewards (4:30) |
· Video 1: Emotions Matter! (2:50) · Video 4: Developing Emotional Awareness (2:50) · Video 7. It's Up To You (3:50) |
Core Articles & Ride the Wild Horse Audio Meditation
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Related Articles
- Nonverbal Communication Skills: The Power of Nonverbal Communication and Body Language
- Playful Communication in Relationships: The Power of Laughter, Humor, and Play
- Conflict Resolution Skills: Managing and Resolving Conflict in a Positive Way
The Science Behind the Toolkit
Dr. Allan Shore - Clinical Faculty & Researcher, Psychiatry & Biobehavioral Sciences, UCLA
Mary Helen Immordino-Yang, Ed.D. - Cognitive Neuroscientist, Brain and Creativity Institute, USC
Bizness Thoughts ...
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August 31, 2010, 7:00 am
Top 10 Reasons for Entrepreneurial Success
By JAY GOLTZ
I really have only one indulgence. I bought an expensive convertible a few years ago. It is not a midlife crisis car; I would call it a midlife celebration car. It is not red. It was a prerecession purchase.
In any case, I was driving to work one recent morning, sitting at a stoplight when a car pulled up next to me and the young man behind the wheel rolled down his window. He shouted over, “How can I be successful like you?”
I sensed he was serious. I appreciated his moxie, and I wanted to give him a great answer. I also knew that I had between five and 10 seconds for the pearls of wisdom to be hatched and delivered. I didn’t panic. I went with my two favorite standbys: make sure your customers are happy and make sure your employees are with the program. The light changed. He seemed pleased with his stoplight counseling. He thanked me, and we both drove off.
But I started thinking: Is that the best I could do? Did I give him enough to get him on his way? Should I have mentioned the “work hard and follow your passion” mantra? No. He certainly has heard that before. Still, I wished I’d had another chance. I feared this would haunt me forever — or at least until lunch. And then, voila! We were at the next stoplight, and he was again next to me, again with his window and mind open. Rebound. I get another shot!
He told me he was graduating from DePaul University, and he wanted to know what else I had for him. By this point, I’d realized that I couldn’t give him the secret to business success in 10 seconds. That would take at least a minute, but I was not prepared. It is an excellent question that requires some thought. I told him I’d post an answer on this blog. So, to you DePaul graduate with moxie, here is what I believe are the most important success factors in business:
1. Look for opportunities to do something better than just about everyone else.
2. Accept risk as a necessary evil. It makes for much less competition.
3. Act responsibly to customers, employees and vendors.
4. Goals aren’t enough. You need a plan. You need to execute the plan.
5. You need to fix the plan as you go. Learn from your mistakes. Most people don’t.
6. Do not reinvent the wheel. Learn from others — join a business group.
7. Make sure the math works. I know plenty of people who work hard and follow their passion but the math doesn’t work. If the math doesn’t work, neither does the business.
8. Make sure that every employee understands and works toward the mission.
9. There are going to be difficult times and you need to be resilient; whining is a waste of time.
10. There will be sacrifices. Work to find a balance so that you don’t become a financially successful loser. It’s not about the income, it’s about the outcome.
That’s my Top 10 list. I’m sure there are more. What do you think is missing?
Updated: You can now read a follow-up to this post.
Jay Goltz owns five small businesses in Chicago.
September 9, 2010, 1:00 pm
It Takes More Than Passion
By JAY GOLTZ
Thanks for the great comments to my last post. Several of the comments made me stop and think about my own situation and experiences. While some very important lessons were passed along, I feel the need to offer a little context on some important subjects.
HHilborn (No. 12) wrote: “Stay out of debt.”
That’s usually good advice. I certainly agree that many, many business people have taken out too much debt, especially early in their business lives when they may have thought they were operating on vision and talent but it was really a wing and a prayer. But debt isn’t always a bad thing. There are good reasons and bad reasons to go into debt. There is a huge difference, for example, between borrowing money that will have an immediate return on investment (a new machine that will reduce labor costs) and borrowing money to fund losses or to expand (especially if you don’t really know if the sales will be there).
Yes, lots of companies fail because they take on too much debt. And there are some people who will just do better when they don’t have debt, both operationally and emotionally. And if I had to take a black-and-white stance on debt or no debt, I would go with no debt. But business is not black and white. Lots of successful companies do take on debt.
Erica (No. 64) wrote, “The ‘follow your passion’ mantra only works if your passion happens to be in high demand and low supply.“
She makes an important point. While passion is critical in becoming successful, I have to report that I have met many business owners who were passionate but still went broke. It takes more than passion; it takes a business model that works. Do you think it would be a good idea to open a book store today because you are passionate about books? Or a music store? How about a video store?
JS17 (No. 67) commented, “Positive cash flow solves almost every problem.” It certainly is true that positive cash flow is a good thing. But there’s a related point that a lot of people are unclear about: you can have positive cash flow and still be losing money. For instance, a business could be living off of customer deposits or credit card debt and show good cash flow — until the whole thing falls apart. Eventually the lack of profit will destroy the cash flow (unless you own an airline!). It’s almost a business Ponzi scheme. Cash flow is always critical; profit is critical eventually.
Liz (No. 78) wrote, “IGNORE THE NAYSAYERS… or at least beware of them.” When I graduated from college and told people that I was going to start a custom picture-framing business, almost everyone gave me grief. “You’re going to waste your degree?” was the most common response (my mother eventually came around). This was 1978 — before entrepreneurship became hot. Those naysayers were wrong, but the naysayers are not always wrong. I have ignored warnings from experienced business people, and they turned out to be right. Let me assure you that the yeasayers can be just as wrong — and just as damaging. Hey, if this were easy, every business would be successful!
Photoman (No. 7) wrote, “Practice empathy.” I don’t know that I would have understood that comment 20 years ago. Now I do. People are different. They have different perspectives. Not everyone is going to react the way I would. It is easy to forget this when you are frantically trying to build a business. Good advice.
Jay Goltz owns five small businesses in Chicago.
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January 5, 2011, 2:05 pm
Top 10 Reasons Small Businesses Fail
By JAY GOLTZ
One of the least understood aspects of entrepreneurship is why small businesses fail, and there’s a simple reason for the confusion: Most of the evidence comes from the entrepreneurs themselves.
I have had a close-up view of numerous business failures —
including a few start-ups of my own. And from my observation, the reasons for failure cited by the owners are frequently off point, which kind of makes sense when you think about it. If the owners really knew what they were doing wrong, they might have been able to fix the problem. Often, it’s simply a matter of denial or of not knowing what you don’t know.
In many cases, the customers — or, I should say, ex-customers — have a better understanding than the owners of what wasn’t working. The usual suspects that the owners tend to blame are the bank, the government or the idiot partner. Rarely does the owner’s finger point at the owner. Of course, there are cases where something out of the owner’s control has gone terribly wrong, but I have found those instances to be in the minority. What follows, based on my own experiences and observations, are the top 10 reasons small businesses fail. The list is not pretty, it is not simple, and it does not contain any of those usual suspects (although they might come in at Nos. 11, 12 and 13).
1. The math just doesn’t work. There is not enough demand for the product or service at a price that will produce a profit for the company. This, for example, would include a start-up trying to compete against Best Buy and its economies of scale.
2. Owners who cannot get out of their own way. They may be stubborn, risk averse, conflict averse — meaning they need to be liked by everyone (even employees and vendors who can’t do their jobs). They may be perfectionist, greedy, self-righteous, paranoid, indignant or insecure. You get the idea. Sometimes, you can even tell these owners the problem, and they will recognize that you are right — but continue to make the same mistakes over and over.
3. Out-of-control growth. This one might be the saddest of all reasons for failure — a successful business that is ruined by over-expansion. This would include moving into markets that are not as profitable, experiencing growing pains that damage the business, or borrowing too much money in an attempt to keep growth at a particular rate. Sometimes less is more.
4. Poor accounting. You cannot be in control of a business if you don’t know what is going on. With bad numbers, or no numbers, a company is flying blind, and it happens all of the time. Why? For one thing, it is a common — and disastrous — misconception that an outside accounting firm hired primarily to do the taxes will keep watch over the business. In reality, that is the job of the chief financial officer, one of the many hats an entrepreneur has to wear until a real one is hired.
5. Lack of a cash cushion. If we have learned anything from this recession (I know it’s “over” but my customers don’t seem to have gotten the memo), it’s that business is cyclical and that bad things can and will happen over time — the loss of an important customer or critical employee, the arrival of a new competitor, the filing of a lawsuit. These things can all stress the finances of a company. If that company is already out of cash (and borrowing potential), it may not be able to recover.
6. Operational mediocrity. I have never met a business owner who described his or her operation as mediocre. But we can’t all be above average. Repeat and referral business is critical for most businesses, as is some degree of marketing (depending on the business).
7. Operational inefficiencies. Paying too much for rent, labor, and materials. Now more than ever, the lean companies are at an advantage. Not having the tenacity or stomach to negotiate terms that are reflective of today’s economy may leave a company uncompetitive.
8. Dysfunctional management. Lack of focus, vision, planning, standards and everything else that goes into good management. Throw fighting partners or unhappy relatives into the mix and you have a disaster.
9. The lack of a succession plan. We’re talking nepotism, power struggles, significant players being replaced by people who are in over their heads — all reasons many family businesses do not make it to the next generation.
10. A declining market. Book stores, music stores, printing businesses and many others are dealing with changes in technology, consumer demand, and competition from huge companies with more buying power and advertising dollars.
In life, you may have forgiving friends and relatives, but entrepreneurship is rarely forgiving. Eventually, everything shows up in the soup. If people don’t like the soup, employees stop working for you, and customers stop doing business with you. And that is why businesses fail.
Jay Goltz owns five small businesses in Chicago.
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March 9, 2010, 3:53 pm
The Secret to Having Happy Employees
By JAY GOLTZ
About 10 years ago I was having my annual holiday party, and my niece had come with her newly minted M.B.A. boyfriend. As he looked around the room, he noted that my employees seemed happy. I told him that I thought they were.
Then, figuring I would take his new degree for a test drive, I asked him how he thought I did that. “I’m sure you treat them well,” he replied.
“That’s half of it,” I said. “Do you know what the other half is?”
He didn’t have the answer, and neither have the many other people that I have told this story. So what is the answer? I fired the unhappy people. People usually laugh at this point. I wish I were kidding.
I’m not. I have learned the long, hard and frustrating way that as a manager you cannot make everyone happy. You can try, you can listen, you can solve some problems, you can try some more. Good management requires training, counseling and patience, but there comes a point when you are robbing the business of precious time and energy.
Don’t get me wrong. This doesn’t happen a lot. There’s no joy in the act of firing someone. And it’s not always the employee’s fault — there are many bad bosses out there. Bad management can make a good employee dysfunctional. On the other hand, good management will not always make a dysfunctional employee good. And sometimes people who would be great employees somewhere else just don’t fit your company, whether it is the type of business or the company culture.
In the worst cases, the problem of a bad fit can have a bigger impact than just one employee’s performance. Being in charge does not necessarily mean you are in control, and being in control does not necessarily mean being in charge. Have you ever seen a company or department paralyzed by someone who is unhappy and wants to take hostages? It is remarkable how much damage one person can do. If you haven’t seen it, I suggest you watch “The Caine Mutiny.” Basically, one guy takes apart the ship. He was unhappy. It only takes one.
This is only my opinion. I don’t have a Ph.D., an M.B.A., or even an economics degree. What I do have is a happy company. And that makes me happy. Now I know some people argue that business is about making money, and not everyone has to be happy. That is also an opinion. Everyone has a right to his or her opinion. When you own a company, you also have the right to surround yourself with the people you choose.
I have spent the last year and a half focusing on cutting costs, figuring out how the market has changed, and worrying about the economy. Things seem to be getting better, or perhaps I am just getting used to it.
Either way, I had a good day today. Not because I got a big order, great financial reports or even an employee stopping by to tell me what an awesome boss I am. (That generally doesn’t happen. You have to tell yourself. It’s a boss thing.) I had a great day because I spent most of it walking around the company and appreciating the fact that even after a year and a half of soft sales and cutbacks and furloughs, I have wonderful people working for me. They care. They are committed. They understand the whole customer-staff-company triangle, where all of the legs support each other.
If you read books on great companies, they usually leave out a dirty little secret. It doesn’t make for good public relations — like talking about how you “empower people” or how your “greatest assets” are your people. Both of these well-worn clichés are true. What is also true is that it’s hard to build a great company with the wrong people.
When you have the right people, business is much easier. I know because I have tried it both ways.
9:25 p.m. | Updated You can find a follow-up post here.
Jay Goltz owns five small businesses in Chicago.
March 11, 2010, 3:54 pm
More on Happy Employees
By JAY GOLTZ
In my last post, I wrote about my desire to have happy people working for me. Perhaps I could have been clearer when I said that I fire unhappy people. Instead of unhappy, I probably should have said disrespectful (to others, not me), incompetent, unreasonable, undependable, irresponsible, unproductive, dysfunctional (I did say that one), angry, whiny or mean — and beyond a manager’s ability to repair (actually, I said that, too). I think most people understood the context of my post, but there were a few comments or questions that required a response.
First of all, more than one commenter substituted the word “cheerful” for happy. I don’t care about cheerful. I care about the list above. Am I sure that my employees are not just acting happy? No! I lost my happy meter. But if they are just acting, that’s O.K., too. Not preferred, but O.K.
When you are in the middle of a recession, the true character of an organization comes out. How is the communication? Are cutbacks handled in a fair and reasonable way? What is being done to react to the new economics? At my company, I appreciate the fact that everyone is working together to get back on track and that my managers can spend all of their time and energy improving operations instead of dealing with issues that cannot be fixed.
I also appreciate that I have good, hard-working people with good attitudes who appear to like working for me. Am I delusional? Maybe. Perception is my reality. They have been here an average of nine years, many more than 20. My first business, Artists Frame Service, is now 20 times the size of the average picture-framing company, making it the largest in the industry. The fact that I have happy employees is not unrelated.
In response to some of the commenters, let me emphasize that I do understand, as I said in the post, that there are many bad bosses. I get it. And firing is certainly not a cure for bad management. It was suggested that we “first try direct communication with the offending party.” I am sorry if anyone got the impression that my managers and I are running around firing people on a whim. As I wrote, we counsel, we listen, and we listen some more when employees raise problems and issues. I encourage and appreciate complaints. If I fired everyone who had complained at some point, there would be very few people here. I would have had to fire myself.
We get complaints of all kinds, and we deal with them — whether it is that the toilet paper is too rough, the lighting is bad or that a manager is not doing a good job. Some complaints are legitimate, some are not, some are about issues that can’t be fixed. If there is a problem with something that someone is doing, we sit down, in private, and discuss the problem. We will do this three or four times. But I have learned that there is a point of no return. No return on your time and energy, and no return on the damage done to customers and employees.
Some people need to work somewhere else, usually to the relief of everyone else. We document. We have a witness. We don’t yell. We also don’t try to win the argument when the employee says it isn’t his fault.
Keep in mind, this blog is written for small businesses. I understand that big business has many different issues when it comes to firing people. Many corporations have legal departments that have no responsibility for productivity, corporate culture, customer service or profits, for that matter. That’s their problem.
Small companies usually don’t have legal departments. They probably should have a labor lawyer, one who counsels on how to manage and fire people legally. Don’t ever want to get sued? Don’t ever fire anyone — and live with the problems. I might add, I have never been sued for firing someone. And I’m tired of hearing people use the desire to avoid lawsuits as an excuse for not taking responsibility for running a company in a productive manner.
It isn’t always fun or easy being the boss. Me? I’m happy. My employees appear to be happy. Then again, maybe I am delusional. Works for me.
Jay Goltz owns five small businesses in Chicago.
Keeping the 'horse' in Horsemanship!
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Keeping the ‘horse’ in Horsemanship!31 December 2010 http://www.horsehero.com/editorial?feat=58718 In 2009 I was lucky to ride in the inaugural Mongol Derby, a 1000km horse race across Mongolia which saw me partner some 25 native Mongolian horses and ride all day, every day, for ten days, across some spectacular terrain. Stuck for imaginative names, they were all called Bob, and all memorable for their intelligence and independence. It was reflecting on the qualities of Bobs 1 to 25 (given my own dressage background) that led me to a reassessment of what I am looking to achieve when training my own horses at home. "Any sore spots?" I am currently home for Christmas and have had the pleasure of working my mum’s dressage horse Tucker a couple of times. It’s a joy to peel his rugs off and admire a horse who quite literally glows with health and happiness. By the time I get in the saddle I will have made numerous concessions to his comfort and well being, all in order to minimise the taxation on his joints and make the efforts we ask of him as easy as possible. While I bandage his legs with gel pads next to his skin to provide a little extra support, he has two heat lamps over his neck and pelvis, and I work a palm into the big muscle groups with an eye on their warmth, yielding texture and his reaction to my touch. We also use a massage pad, which aids lymphatic drainage and with it the elimination of waste products from his system. Any sore spots? How does he stand and step back and to the side when I ask him to move round me in the stable? I use all of this information when I get in the saddle and start to work him. "In the arena, I am boss!"
Oblivious to hazards… What I have noticed since coming back from riding the wilder, native horses in Mongolia, is that this dominance and precision of every movement is not without consequences. Out hacking when I need him to pick a sensible path over slippery, rutted or sloping ground, he hasn’t got a clue. In fact, if a bird gets up in front of him or something else catches his eye, he won’t give what’s under his feet a second thought and will turn to look at things with his whole body, oblivious to hazards and transfixed by the smallest natural distraction. Navigating a suitable path, apparently, is still my responsibility. Having taught him to await my instructions and let me position his body quite minutely, it’s as if his ‘horsey’ autonomy and instincts have been blunted, or replaced altogether. His instinct is to trust me not to put him in a pickle. In the same way, I regulate his diet, his body temperature, his routine of turnout, work and rest, the company he keeps, all for his own good, though indirectly for my own in pleasing me. "Pause for thought"
"Shaped by their own actions and instincts" Having ridden one Derby and been involved in organising the event for 2011, the very last thing I feel for these formidable little horses is sympathy. As tough as their lives are (and surviving on meagre rations through a winter with temperatures plunging to minus 40 degrees is most certainly tough), they enjoy a degree of freedom that Tucker, and most of his ilk, will never have the chance to experience. Their existence is gloriously free from human interference and they live, eat, mate, age and die in herds shaped by their own actions and instincts. They are fit, not because they are worked daily by a rider and trained to be fit, but because their survival requires it. The brief periods they spend under saddle do not ‘teach’ them anything except that they may have to comply with a person from time to time, that ‘go’ means ‘go’ and ‘stop’ means ‘stop’. The finer details are left to the horses, and they quite dexterously navigate some very testing ground with a kind of nonchalance which left me feeling quite dizzy at times, imagining the various flavours of sticky end I had just risked had I been mounted on a common or garden warmblood. "Seeing horses as horses"
Clearly, there are some parts of the dressage curriculum (if we take the sport of dressage, as that's the one I hail from) which apply universally and benefit the health of the horse as well as the enjoyment of the rider; for instance suppleness, straightness, general gymnastic ability and sensitivity. As well as helping the horse last well into old age, they make a horse pleasant to be around and work with. However, I think we risk taking something away from our horses by focusing only on their ability in the dressage arena. It’s the equivalent of only running on a treadmill - fine if you are recovering from surgery perhaps, but a very limited form of exercise for the overall health of the individual. Overall fitness requires co-ordination, mental toughness and stamina, proprioception and agility, and focusing only on the power and cadence with which the horse moves, how long he can sustain this way of going, and his ability to concentrate on his rider and await very nuanced instructions, fails to stimulate, or even erodes, these other skills. "Are horses taking on a raft of human neuroses?"
It’s natural to worry about the horse you spend all of your spare money on, and pay very close attention to his health and well being. In fact, it’s part of being a responsible owner. On the other hand, you don’t see that many horses in the wild tripping over their feet, over-reaching, eating poisonous plants in dangerous quantities, fighting to the death with other horses or falling down fox-holes. In other words, hazards tend to be self-limiting, if they are allowed to be. "More capable than we give them credit for?" Rather than never allowing your horse to face a hazard, consider what instincts he has as an animal, a horse, a herd creature and how he is equipped to handle what life throws at him. They are probably more capable and intelligent than we give them credit for. By the same token, they don’t forget skills and habits they accrue through their lives. Time spent thinking about their last training session could be as valuable as another identical training session designed to reinforce everything once more. 3. Is that recognisable ‘horse’ behaviour?Horses aren’t evolved to live as most stabled competition horses do. This isn’t to say they aren’t wonderfully content and happy to be around their people, have their food brought to them at regular intervals and stand still snuggled up in plenty of rugs. However, I think we owe it to the animals in our care to let them express themselves as animals, first and foremost. The mare I currently bringing on as a novice endurance horse is a hilariously strong character. She lives out in the day with three other mares, and they jostle for status, enjoy hormone-fuelled spats and fight for the same patch of grass and pile of hay. "I set the overall direction, and she handles the details" If I interrupt her in the middle of such a spat, she pulls some pretty funny faces. I actually find it really cheering that her first loyalty is to herself, and that she doesn’t look at me and see a feed, a treat, an exchange which conditions her to please me. As long as she is respectful of my personal space and is safe to ride and handle, I don’t think she needs further socialisation with me. We are firm friends, but she is a horse and I am a human, and under saddle, I set the overall direction, and she handles the details. The overall direction includes being supple to both sides, yielding to my leg and keeping a proper contact. In fact, she’s on the bit and stretching forwards like a ‘proper’ dressage horse. Just don’t tell her that - she’d be furious! I suppose my conclusion is that developing a horse to their maximum potential and well being is about more than their way of ‘going’- there is also a way of ‘being’, where they are allowed some autonomy to think for themselves and act like a horse.Editor's Note: The Horse Hero competition to win a place on the 2011 Mongol Derby, opens January 10th. |
