San Diego Elder Answers
Expert advice for people caring for a loved one

Family and Medical Leave

Are you stretched thin, trying to work and care for your family member? You may be able to take job-protected time off. You won’t get paid. But you are assured that you can come back to your same (or nearly the same) job.

The national Family and Medical Leave Act (FMLA) gives eligible workers up to 12 weeks of unpaid leave time each year. You can use this time to address family or personal medical issues. It covers time off to

• care for a family member with a serious health condition;
• recover from a personal serious illness or injury of your own; or
• give birth to or bond with a newborn, adopted, or foster child.

The FMLA allows family caregivers to take all 12 weeks of leave at once. Or you have the choice to spread that leave time, as needed, over the course of a year.

Your eligibility depends in part on your employer. You must work for either

• a private company with more than 50 employees within 75 miles of your worksite;
• a government agency (city, county, state, or national);
• a public or private elementary or secondary school (of any size).

You must also have worked for your employer at least 24 hours/week during the past 12 months.

Your employer may ask for a doctor’s certification that your relative has a serious health condition. For example, that your family member

• required overnight care in the hospital or other medical facility;
• has an illness that has lasted more than three days and requires further treatment; or
• is chronically ill and experiencing an incapacitating flare-up in symptoms.

Ideally the doctor’s letter would mention your loved one’s need for ongoing assistance and support.

If you think you might be eligible, ask your supervisor for more information or go to the website of the Department of Labor: www.dol.gov/whd/fmla.

Is your loved one depressed?

We all get the blues now and then. But depression is different. It is more than a passing mood. Depression is actually a biochemical imbalance in the brain. It’s not something you can just “snap out of.” It requires treatment.

In general, there are nine symptoms of depression. If a person experiences four or more of these symptoms every day, for most of the day, over a two-week period, medical professionals would call it “major depression”:

• Feelings of sadness, which may or may not include crying spells
• Loss of interest or pleasure in normal activities
• Changes in appetite leading to a 5% weight loss or weight gain
• Slowed speech, slowed reactions, slowed movements
• Changes in sleep habits
• Confused or distracted thinking
• Fatigue
• Feelings of worthlessness or guilt
• Frequent thoughts of death, dying, or suicide

Depression is extremely common in the elderly. But it is often not diagnosed. This is very sad, literally. Because depression can be treated and resolved.

A big reason depression goes unrecognized is that many of the symptoms seem common in older adults. Fatigue, for example, or reduced appetite may be wrongly considered “normal” side effects of age. Or they may be a side effect from a medical condition or treatment.

Fortunately, studies show that just two simple questions are enough to effectively screen for depression in the elderly:
In the past two weeks, how often have you

• felt down, depressed, or hopeless?
• found yourself with no interest or pleasure in doing things that you used to like?

If the answer is “more than half the time” for both, or “every day” for just one, then the older adult should consult with a doctor. There is a good chance he or she has become depressed and could benefit from treatment. (And if any of this sounds like you, talk with your doctor! Depression is also common among family caregivers.)

What is palliative care?

People with a serious illness sometimes experience distressing symptoms. This can be a result of their medical condition. Sometimes the symptoms are from the treatment itself!

That’s when palliative care comes into play. A palliative care professional focuses on removing distress, regardless of the cause. What counts as distress?

• Pain
• Shortness of breath
• Extreme fatigue
• Loss of appetite
• Nausea, constipation, or diarrhea
• Trouble sleeping
• Depression or anxiety

Palliative care is “comfort care.” Its goal is to improve the patient’s quality of life. Other professionals focus on curing the underlying condition. The purpose of palliative care is to make each day the best day it can be.

Palliative care specialists work with many different “tools.” These treatments include traditional drugs and therapies. But there is more. Massage, acupuncture, and dietary approaches may be used. Emotional and spiritual pain are also considered “distress.” As a result, comfort care teams often include experts in psychology and spirituality.

Many people mistakenly think palliative care is available only for the dying. This is not true. Hospice care is a branch of palliative medicine. But anyone with a serious condition can ask for a consultation with a palliative specialist. Just as your loved one might go to a heart doctor to fine-tune treatment, he or she can go to a palliative specialist for relief from distress.

In a palliative care program, your relative does not have to stop curative care to receive comfort care. Consider how your loved one has been feeling. Might he or she benefit from comfort strategies? If you think so, ask his or her doctor for a consult with a palliative care specialist.