Care knowledge for relatives

Caring for relatives is a demanding task, for example because the elderly and people in need of care often have a weaker immune system than healthy and younger people plus wounds tend to take longer to heal. As a result, everyday problems, minor infections and wounds can quickly result in bigger issues. Chronic illnesses also place high demands on caregivers. 

Careful and holistic care helps to detect and treat problems at an early stage so that they do not impair other bodily functions. For example, pain can cause a loss of appetite. If this persists, it can result in malnutrition and less exercise. This increases the risk of falls, which cause injuries and can further increase the need for care. 

The provision of care is easier for both those in need of care and their relatives if they know: 

• what affects general health 
• the correlations between individual factors such as diet, exercise, physical and mental illnesses or symptoms 
• which concomitant symptoms and secondary diseases are possible with existing illnesses 

Care knowledge can also help avoid abuse during care: people with a genuine desire to provide care can damage the physical and mental health of the care recipient as a result of excessive stress, carelessness or ignorance. 

Care services and long-term care insurance providers are responsible for providing advice and guidance to family caregivers. If you need help quickly, you can contact your general doctors’ practice. 

What does “enabling care” mean? 

Even if care recipients are severely limited in their abilities, it is important for them to do as much as possible themselves – with support when necessary. This helps them maintain and restore their abilities and makes them feel that they can still do some things themselves. 

Caregivers can provide assistance and encourage people to do things themselves. Accessible homes and medical aids also help care recipients to independently complete everyday activities. There are medical aids available for almost every area of life and all activities. 

If care recipients remain passive, they will become increasingly dependent over time and their physical and mental abilities will deteriorate. Furthermore, exercise stimulates both the respiratory system and the circulation and helps to prevent further illnesses (for example pneumonia or thrombosis). A lack of exercise leads to a loss of muscle strength and increases the risk of falls. As a result, the need for care increases further. 

An adequate and balanced diet is particularly important for care recipients. Elderly people are at greater risk of malnutrition, vitamin deficiency and dehydration.

If care recipients refuse to eat and drink or have little appetite, this can be due to toothache, swallowing difficulties, a lack of thirst or hunger or a lack of independence when eating and drinking, for example. Medication can also affect the appetite. Furthermore, people with dementia who experience a heightened urge to exercise burn a high number of calories.

The elderly or people in need of care can also simply forget to drink or intentionally drink small amounts to prevent the need to urinate. Diuretic medication can also contribute to fluid loss.

Tips on healthy, wholesome diets for the elderly can be found in the article Healthy aging – with a balanced diet and plenty of exercise. 

It is also important to

• help care recipients eat and drink independently. Medical aid such as non-spill cups and special cutlery can assist with this.
• rule out chewing and swallowing problems: check the mouth, tongue, teeth and dentures for problems and seek advice from a doctor, dentist or speech therapist if necessary.
• adapt the diet of care recipients and people with disabilities during heat waves in summer. This helps to prevent dehydration.

Further information and dietary advice for people in need of care, especially on malnutrition and dehydration, can be obtained from the Center for Quality in Care (Zentrum für Qualität in der Pflege – ZQP).

What are the key dietary considerations for people with disabilities? 

People with certain disabilities and chronic illnesses are at a higher risk of obesity (becoming severely overweight). This includes people with autism, learning disabilities, Down’s syndrome or spina bifida, for example. The reasons for this include poor eating habits. With some conditions, obesity can also be genetic.

An excessively high body weight can in turn increase the risk of cardiovascular diseases and diabetes mellitus. However, it can also exacerbate complications caused by the disability itself and impair people’s self-determination, independence and quality of life.

Explaining the importance of a healthy diet and plenty of exercise to people who have a disability or who are in need of care can help to avoid obesity. With some disabilities or illnesses, it can help to use diet plans that have been tailored to the metabolism. These can be created within the scope of a dietary consultation. Please contact the person’s doctor to this end.

The Special Olympics Germany association (Special Olympics Deutschland e.V.) provides information about healthy eating in simple language (in German only).

As people age, they become more prone to wounds that are easily inflamed. Many people in need of care also experience acute and chronic pain.

How can skin damage be avoided?

As the elderly and care recipients age, their skin becomes thinner, drier and more wrinkled. This makes it more susceptible to irritation and inflammation. Skin problems can lead to minor wounds that become easily inflamed. This can be due to incontinence, heavy perspiration, extended periods of lying down, overly intensive washing or incorrect skin care, for example.

Appropriate skin care includes:

• regularly cleansing the skin and caring for it with suitable products, for example lipid replenishing creams
• keeping the skin and wrinkles dry
• looking out for any signs of skin problems and obtaining professional advice at an early stage if necessary
• in the case of disorders such as incontinence and diabetes, caring for the skin particularly thoroughly and monitoring it carefully

Further professional tips on skin care can be obtained from the Center for Quality in Care (Zentrum für Qualität in der Pflege – ZQP). 

How can bedsores (decubitus) be prevented?

People who find it difficult or are completely unable to move independently can easily develop bedsores (decubitus) when lying down or sitting for too long. Persistent pressure on the same area damages the skin and the tissue below it. If not properly treated, superficial redness can develop into deeper, painful wounds.

Skin care and diet also play a role in the way that pressure sores develop and heal: irritated and damaged areas of skin are particularly susceptible to bedsores; malnutrition and dehydration affect the skin and slow wound healing.

Tips for preventing bedsores: 

• Incorporate as much movement as possible into everyday life.
• Regular changes of position are required when lying down for extended periods. Even small changes in position can be helpful.
• If caregivers need to help people change position, lifting techniques and medical aids can relieve the strain on their back. Care services can provide relatives with guidance and training.

Bedsores can take a long time to heal. It is therefore important to obtain professional advice even in the case of redness. Wounds and bedsores should always be treated by nursing professionals or wound managers. 

Professional tips for family caregivers on the prevention and treatment of bedsores can be obtained from the Center for Quality in Care (Zentrum für Qualität in der Pflege, ZQP).

Dealing with pain

Pain should always be taken seriously and treated as it can affect people’s health and wellbeing. For example, it can not only cause a loss of appetite and sleep disorders but also dampen people’s enjoyment of life and even lead to depression, in turn increasing the need for care. If left untreated, pain that persists for a long time can also become chronic.

Elderly people often suffer from chronic pain. This can be treated with medication but also through the use of other therapies and medical aids. Professional medical treatment is advisable.

Also ask if household remedies are suitable: heat, cold, massages and relaxation techniques can sometimes be used to alleviate pain in consultation with a doctor. 

How can I tell if people who are unable to express themselves are in pain? 

In the case of people who are unable to communicate or who struggle to explain pain, restlessness and irritability, sleep disorders, a tense or pinched facial expression and a change in posture may be indications of pain. 

Further information on identifying and treating pain in people with dementia can be obtained from the German Alzheimer’s Society (Deutsche Alzheimer Gesellschaft e.V. – DalzG).

Many elderly people with disabilities who are in need of care take several forms of medication. It is important to use and store these as indicated on the prescription so that they work correctly and no medication errors occur. Some forms of medication can be addictive.  

Care recipients sometimes take medication incorrectly. This is often due to memory and vision problems, limited mobility and swallowing issues: visual impairments can result in medication being mixed up; shaky and stiff fingers can make it hard to remove tablets from blister packs. Caregivers can arrange several days’ worth of tablets and pills in a medication box.  

Fixed times and routines help people take medication at the right time. For example, by always taking tablets after brushing the teeth. Alarm clocks, smartphone apps and digital medication dispensers can also be useful. 

Tablets, capsules and pills should not be broken up or crushed as this can modify their effect. In the event of swallowing difficulties, medication can be given in a spoonful of apple sauce or porridge, then washed down with a little water. 

Many elderly people take several different forms of medication. An up-to-date medication chart – in paper or electronic format – helps to retain an overview of all medication and avoid interactions: all current medication is recorded in a list together with the relevant dosages. This also applies to over-the-shelf and naturopathic products.  

Medication that is unsuitable for elderly people is listed in the PRISCUS list. Consult the care recipient’s doctors about this. You can obtain the list from Witten/Herdecke University (Private Universität Witten/Herdecke gGmbH).

As many care recipients have a weakened immune system, hygiene when taking medication is particularly important: always wash the hands first, ensure that containers are clean and wear disposable gloves when applying ointments that contain active ingredients. 

Further information and advice on medication for care recipients can be obtained from the Center for Quality in Care (Zentrum für Qualität in der Pflege, ZQP).

Recommendations on medical treatment for dementia can be obtained from the German Alzheimer’s Society (Deutsche Alzheimer Gesellschaft e.V. – DalzG).

What if medication use becomes problematic? 

Some forms of medication, such as sleeping pills, strong painkillers or psychotropic medicines, can be addictive.  

Addiction problems can rarely be resolved through self-discipline. Furthermore, the use of medication must not be reduced or discontinued without medical advice. Care recipients or relatives who notice that there is a problem can obtain professional advice and assistance from addiction advice centers and addiction self-help associations. You should also consult the care recipient’s doctor. 

The signs of addiction are not always overtly apparent: many of the symptoms that could indicate a problem can also be age-related. The list of all medication and its usage can provide further indications. 

Further information on the topic of addiction in old age and how to recognize addiction problems can be obtained from the Centre for Interdisciplinary Addiction Research (ZIS) of the University of Hamburg. 

Hygiene and cleanliness in the following areas help to prevent infectious diseases and inflammation: 

• Personal and oral care of the care recipient
• Personal hygiene of the caregiver, especially clean, well-cared-for hands
• Household cleanliness and cleanliness when preparing food

What considerations are required in relation to personal care?

Good personal care promotes wellbeing and keeps the skin healthy. People whose flexibility, mobility or cognitive abilities are restricted often need support in this regard. This requires sensitivity from the caregiver.

Allowing care recipients to do as much as possible on their own promotes their mobility and independence. Shower chairs or bath and toilet attachments can be helpful. 

Further tips on personal care and handling situations involving a sense of shame can be obtained from the Center for Quality in Care (Zentrum für Qualität in der Pflege, ZQP).  

What considerations are required in relation to oral care?

The care given to the teeth, dentures, lips and mouth affects the intake of food, speech and ultimately social contact.

Only drinking small amounts or taking diuretic medication can cause a dry mouth. This can lead to a loss of taste or painful incrustations on the tongue.

If left untreated, periodontitis can increase the risk of cardiovascular diseases, diabetes or lung diseases.

For information on what constitutes good oral care, please see the article Oral hygiene and preventive dental care for healthy teeth. 

The following also apply to caregivers:  

• Help the care recipient with their oral care or brush their teeth for them if necessary.
• Look after dentures well. Poorly fitting dentures can cause pressure points and inflammation.
• Also clean and care for the care recipient’s lips, tongue and oral mucosa.

Regular dentist appointments can prevent oral and dental problems. Health insurance providers cover additional services for people with disabilities and people in need of care, such as the creation and review of an oral health plan.

Tips on oral care can be obtained from the Center for Quality in Care (Zentrum für Qualität in der Pflege, ZQP).

Further information on oral care and dental services can be obtained from the Federal Dental Association (Bundeszahnärztekammer).

People with mental impairments such as dementia often resist oral care and dental treatment, especially if they are in pain. In such situations, it can help to use simple language to explain every step that you or the dentist will take.

Some dental practices specialize in treating people with mental impairments. Addresses can be obtained by using the dentist search function provided by the National Association of Statutory Health Insurance Dentists (Kassenzahnärztliche Bundesvereinigung KdöR – KZBV). 

Care, household and food

Strict hand hygiene when performing care activities, in the household and when handling food and drinks can prevent the spread of viruses and bacteria (smear infection).

Disposable care aids such as gloves, bed protectors and incontinence products like pads or pants should therefore only be used once.

It is not only important for caregivers to thoroughly wash and, if necessary, disinfect their hands, but also for them to care for their hands with lipid-replenishing creams to prevent them from becoming dry and cracked.

If the caregiver is ill, a face mask can prevent contraction – even in the case of minor infections. It may also be possible for others to assist with the care until the illness has passed.

Further information on hygiene and the prevention of infections when providing care can be obtained from the Center for Quality in Care (Zentrum für Qualität in der Pflege, ZQP).

Incontinence can cause insecurity and health problems such as skin damage and infections. However, it can also have mental and social consequences, such as social withdrawal and loneliness. Proper and respectful care helps to avoid these. 

Caregivers can prevent infections by immediately removing urine and feces as well as regularly cleaning and caring for the genital area. 

Some people who suffer from incontinence avoid social contact for fear of smelling bad. This can be prevented through the correct use and regular replacement of incontinence products as well as by washing bed linen and clothing at hot temperatures. 

Further information on caring for people with incontinence and bladder weakness can be obtained from the Center for Quality in Care (Zentrum für Qualität in der Pflege, ZQP). 

People who are unable to breathe independently receive ventilators that breathe for them or support their breathing. This is also possible away from a hospital, i.e. at home, when travelling, at school and during other everyday activities.

A distinction is made between non-invasive ventilation, which uses a nasal or full-face mask, and invasive ventilation, where artificial access to the windpipe is provided.  

Non-invasive ventilation can usually be performed independently or with the aid of relatives; invasive ventilation requires support from an intensive care service that specializes in out-of-hospital ventilation. 

Its duties include providing guidance to relatives to enable them to perform certain tasks if the person who is ventilated so wishes. 

The following areas are important when caring for people on ventilators: 

• Mouth care and sufficient fluids to avoid dry mucous membranes, inflammation and fungal infections, which in turn make it hard to eat – even in the case of full artificial feeding.
• Strict hygiene as people on ventilators are particularly susceptible to infections. Pathogens can spread in the body via an artificial access point. 
• In the case of invasive ventilation, the airways must be regularly suction cleaned to avoid irritation and inflammation, shortness of breath and, in the worst case, pneumonia.

Information on out-of-hospital ventilation and how to recognize good ventilation care can be obtained from the Center for Quality in Care (Zentrum für Qualität in der Pflege, ZQP).

The following care services help care recipients and their relatives ensure suitable care: 

• Training for relatives: this includes training on techniques and the use of medical aids as well as information about certain illnesses and medical conditions plus the associated requirements regarding care at home. Such training can be provided by care support points and long-term care insurance providers, for example.
• Professional guidance on care: the duties of a care service (care benefits in kind) include providing care recipients and their relatives with guidance and advice in certain care situations.
• Carer review visits: care workers visit the care recipient at home to see if the care is ensured. They also provide tips on how to improve the care. These visits are mandatory for people who only receive nursing care allowance. In the case of people who receive care benefits in kind or who have care level 1, they are optional.

The assessor from the medical review service can also provide recommendations in the care assessment as to the measures that could be used to improve or stabilize the need for care: rehabilitation measures, preventive measures and medical aids can be directly applied for within the scope of the assessment. The recommendation from the medical review service replaces a medical prescription and a professional review of the need for care. 

Further information about medical aids available for care purposes can be obtained from the consumer advice centers.

Family caregivers are entitled to various health insurance benefits for the purposes of health promotion and prevention. These include nutritional advice, health courses and sports courses, for example. Information about the options available and the costs that are covered can be obtained from your health insurance provider. People with private health insurance can obtain information from their contract documents or their insurance company.