caregiver self- management program · physical functioning, which leads to more stress for...

Caregiver Self-Management Program

Handbook

Session 1 Understanding the Role and Stress of Caregivers

v Work and Role of Caregivers v Understanding the Relationship Between Caregivers

and Care Recipients v Understanding the Boundary v Understanding the Sources of Stress for Caregivers v Guidance for Caregivers v Benefits for Caregivers v Introduction to Body-Mind-Spirit Caregiver Model v Health Exercise 1：Clapping Procedure, Waist Rotation

and Shoulder Patting, Ten Hand Exercises

USC Edward R. Roybal Institute on Aging USC Suzanne Dworak-Peck School of Social Work

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Based on different natures of work, caregivers can be classified as employed and non-employed. The main differences between the two are:

Employed Caregivers Non-employed Caregivers

Have choices？

Participate in caring for care recipients by choice

Usually without choice or preparation. Take the responsibility of caring for care recipients due to physical decline or illness, such as stroke or Parkinson’s disease, which leads to difficulties in daily activities

Paid？ Paid after the completion of work

No monetary returns

Training Most are trained before or at work

Most have not received formal training

Caring for care recipients

Need to work according to specific schedules and guidelines

No specific work requirements, but need to take care of everything care recipients need; provide care on his/her own or seek assistance from formal services

Duration of care Based on caregivers’ personal preferences

Based on care recipients’ needs and bodily functions; keep working until care recipients no longer need care

Examples Staffs in hospitals, nursing homes, and adult daycare centers

Family members, relatives, neighbors, volunteers

Work and Role of Caregivers


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Brainstorm Based on your own experience, answer the following questions： 1. Are you a caregiver or care-receiver most of the time?

a. I am a caregiver most of the time. b. I am a care-receiver most of the time. c. Both

2. When caring for care recipients, you will:

a. Assist them to complete tasks. b. Serve care recipients so that they do not need to work on tasks by themselves at all.

3. When care recipients need to do something, such as eating or bathing, you will:

a. Provide guidance so that they can complete it on their own. b. Do it for them to save time for both sides.

4. How is the relationship between you and care recipients to whom you are providing care? What factors lead to this kind of relationship?

a. Good, because ____________________________________________ b. Okay, because ____________________________________________ c. Bad, because _____________________________________________

5. What impacts do you think this kind of relationship will have in your care work? _____________________________________________________________ _____________________________________________________________ 6. Have you ever felt stressed about caring for care recipients and want to give up? a. Never. b. Used to feel/now feeling stressed, because ________________________ _____________________________________________________________ 7. How do you face/tackle these stresses/worries? _____________________________________________________________ _____________________________________________________________ 8. Recall what makes you happy/gratified in the course of caring for care recipients: _____________________________________________________________ _____________________________________________________________


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The Role of Caregivers Caregivers should understand their own role and the basic principles of providing care: 1. Caregivers and Care-Recipients

² Caregivers are often also care-receivers at the same time. ² When providing care, caregivers need to take good care of themselves, and

accept others’ assistance. Otherwise, it will be hard for them to care for care recipients over the long term.

2. Assistance and Service ² Care recipients are able to accomplish easy tasks, even if they have chronic

diseases, weak bodily functions, or difficulty moving. ² Therefore, caregivers should have a clear understanding of care recipients’

abilities, assist and complete tasks with care recipients together. Examples include providing assistance tools: to help with putting on shoes/socks, picking up stuff, etc. Or, when care recipients wash their face, caregivers should provide them with basin and a wet towel, and hand over the towel to care recipients so that they can wash face on their own. Caregivers should allow enough time for care recipients to complete the task.

² Even when caregivers are paid, they should keep in mind that their role is to be an assistant. Caregivers are not supposed to do everything on behalf of care recipients.

² In fact, if care recipients can complete some tasks for themselves or others, they will feel a sense of control over their life. This can increase their independence and self-esteem.

3. Guidance and Replace ² Sometimes, caregivers complete everything on behalf of care recipients to save

time. However, excessive care and service will increase care recipients’ insecurity and sense of helplessness, and increase their self-perception as a burden to others.

² Therefore, as mentioned, caregivers should guide and assist care recipients to take care of themselves instead of doing everything for them.

4. Empathy and Sympathy ² Caregivers should understand care recipients’ limitations, evaluate their

remaining abilities, and provide proper care. ² Rational empathy is more important than pure sympathy. If there is only

sympathy, it is easy for caregivers to neglect care recipients’ abilities, and thus provide excessive care, which make the care recipients perceive themselves as useless.


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Principles of Providing Care ² Try best to enhance the care recipients’ independence, and abilities to care for

themselves. Do not do everything for them. ² The role of caregivers is to be assistants and a guide instead of substitutes.

Caregivers should allow care recipients to accomplish tasks they are still capable of doing.

Objectives: understand how the relationship between caregivers and care recipients can affect the quality of care provided. Relationship between Caregivers and Care Recipients:

² A good relationship will help caregivers develop a deeper understanding of care recipients’ psychosocial and physical conditions, so that caregivers can identify the care recipients’ needs in advance, effectively assist them to adapt to the changes due to aging, and maximize their remaining abilities and strengths.

² This is especially important for family caregivers who do not earn monetary returns. This will make both caregivers and care recipients feel happy and engaged in the caring process. For paid caregivers, this can also enhance their engagement and motivation.

² On the contrary, in a bad relationship, care recipients may be abused, neglected, or receive poor quality of care, while caregivers will feel stressed, bored of care work, and even anger towards care recipients.

Factors Leading to a Bad Relationship

² Bad relationships are often caused by misunderstandings. If caregivers do not understand care recipients’ needs or effects of diseases, care recipients can be misunderstood for not cooperating or being too demanding. This can easily lead to a vicious circle. Care recipients will then refuse to be cared or cooperate with caregivers.

² For in home caregivers, past relationships with care recipients prior to the illness will also influence caregivers’ attitude. For example, an unhappy marriage, and chronic tension between mother-in-law and daughter-in-law can cause conflicts between caregivers and care recipients. They will devalue each other. In this case, informal caregivers often feel tired and may be reluctant to provide care.

Understanding the Relationship between Caregivers and Care Recipients


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Other factors leading to a bad relationship： 1. Lack of preparation

² Caregivers take over the heavy job of caring for care recipients without enough psychological preparation, thus it may be difficult to adapt.

2. Sense of Loss ² Caregivers may have to quit jobs or spend less time with families and friends in

order to care for care recipients. 3. Distance from Social Networks

² Providing care is time-consuming, so caregivers cannot participate in social activities.

4. Nature of work（physical and psychological） ² As a full-time caregiver, an individual can lose their social status, and

opportunities for further study and/or job advancement. ² Different natures of the caring work have different influences. Caring works that

require a lot of physical activities, such as lending arms, bathing etc, tend to make caregivers feel exhausted. If care recipients have dementia, it is even harder to gain cooperation and effective communication. Such situation can be frustrating and exhausting caregivers.

5. Increased demand ² The care needs of care recipients increases with the change or decline of their

physical functioning, which leads to more stress for caregivers. 6. Long-term Stress

² If caregivers suffer chronic and multiple stressors, and are not being able to address them. They can easily become agitated or tense.

7. Financial Stress ² Caregivers may have increased expenditures due to caregiving, at the same

time, have decreased income due to caregiver duties and taking time off work.

All the negative relationships above are avoidable, and we never want them to happen!

Types of Boundaries There are two types of boundaries – personal boundaries and professional boundaries.

Understanding the Boundaries


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² Personal boundaries are about caregivers’ own expectations. How do they want to be addressed and treated?

² Professional boundaries are guidelines for professional caregivers at work. They describe how to speak and react to the client and family members. This can include the use of first names or last names, participation at family events, and sharing personal information.

Often the professional and personal boundaries overlap. 1. Personal boundaries Boundaries are the lines that define your own personal space (e.g., duties, emotions). Crossing the line means violating a personal boundary. Another way to describe it would be knowing what you’re responsible for and what you’re not, and what is your need and what is somebody else’s need. If you want people to treat you the way you want to be treated, you need to tell them about your own boundaries. Caregivers need to learn about setting boundaries in order to maintain a healthy relationship between themselves and their care recipients.

² Identify your boundaries: How do you want people to speak to you? What behaviors are acceptable? Will you tolerate people raising their voices or making jokes?

² Tell people what your boundaries are: Learn to say no. Tell people how to treat you, using an assertive communication style. Remind yourself how you want to be treated, for example, that you are a mature person and a professional caregiver.

² Enforce your boundaries: Don’t let others invade your space or let them make you uncomfortable. Tell them in a polite and assertive way when they cross the line.

2. Professional boundaries Maintaining professional boundaries means to set limits with personal involvement, feelings, and sharing of personal information. Having boundaries is a part of maintaining professional standards. Here are some guidelines for professional caregivers.

a. Sharing personal information ² Share personal information only if you think it may help the individual. ² Don't talk about your own problems; the client may start worrying about

your problems. b. Personal relationships

² As a professional caregiver, you are in the person’s home as a professional, not as a friend.


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² Don't tell sexually oriented stories or jokes. Don't flirt. ² Don't use terms like honey or sweetie. They can be disrespectful and can

create the impression that you are showing a personal interest. ² Maintain a professional demeanor when you witness the client’s disability,

pain, or personal problems. If you feel yourself getting emotional or worried personally, speak to your supervisor or seek guidance from another trusted individual.

c. Touch ² Use touch sparingly. When you provide personal care, be respectful of the

other person’s modesty and sense of privacy. ² Don't assume that people like to be hugged. ² Don’t let clients touch you in a way that makes you feel uncomfortable.

d. Personal appearance ² Choose clothing that makes a professional impression. Clothes should be

neat and not too casual or revealing. ² Choose personal hygiene products (make-up, cologne, aftershave)

carefully. Keep your hair and nails groomed without appearing flashy. Limit jewelry.

e. Gifts and favors ² Follow your agency’s policies on gifts. Report offers of large gifts to your

supervisor. ² Don't use the clients’ personal items (clothes, telephone, etc.) for your

personal use. ² Don't ask for a loan of money, car, or other items. ² Don't buy or sell items from or to your client.

f. Work schedule ² Stick to your scheduled work time. You should be punctual, and you

should expect to leave on time, unless the client cannot be left alone. ² If you spend unscheduled time with the individual, boundaries may be

crossed. If the person needs more assistance, tell your supervisor. If you feel you want to stay, you may be crossing the line between work and personal relationship.

² Don't feel guilty for leaving when your work is done. g. Secrets and confidential information

² Don’t share information about your agency or co-workers. Don't express frustration about your job.

² Do not keep personal secrets with a client.


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Whether paid or unpaid, caregivers often feel pressure and stress caring for one or more care recipients. In-home caregivers face more pressure because they are often taking care of the care recipients on their own. Sources of Stress Nature of the Work

² Providing care is very physically demanding. For example, caregivers need to assist care recipients with taking baths and using the toilet, which can make caregivers feel exhausted.

Care recipients’ Illness

² If care recipients are disabled because of illness, the care they need may become more difficult and complicated. Some care may be discomfortable, such as changing of adult incontinence pads.

Health Condition

² For caregivers who are older, it becomes even harder to provide care when they are also not in great health condition themselves.

Financial difficulties

² Increase spending may lead to financial hardship, for examples include medical expenditures, rehabilitation devices and tools purchase, taxi expenses, etc. In addition, in-home caregivers have to give up working to take care of the care recipient.

Lack of Support

² This is very common among in-home caregivers, because they can lack support from families, friends, and neighbors, and not know how to seek assistance and resources. (How to seek assistance is discussed in Units 22 and 23).

Resistance in taking the responsibility of caring for care recipients

² Some people are scared of old age. Therefore, they refuse to accept care recipients, and feel stressed when caring for care recipients.

² Employed caregivers have a choice. In-home caregivers, however, may have to take up the role without choice and preparation. Therefore, in-home caregivers may feel more stressed and resistant.

Understanding the Sources of Stress for Caregivers


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Influences of Stress on Caregivers The stress can cause harm to caregivers physically, psychologically, socially, and mentally: Physically

² Fatigue ² Injury, such as lumbar sprain when assisting care recipients ² Sleep deprivation or chronic insomnia ² Prone to illness, such as headache, bone pain ² Loss of appetite, loss of weight

Psychologically ² Bad mood ² Angry and guilty – often appear at the same time, because caregivers feel guilty

of being angry to care recipients. ² Helplessness – caregivers sometimes feel helpless, especially when they devote

all their time and efforts to care for care recipients, at the same time, the care recipient may continue to decline.

Socially ² Loneliness ² Feel distant from friends

Mentally ² Depression ² Slight anxiety ² Prone to agitation

These symptoms simultaneously appear and have causal effects upon each other, and make caregivers worried and stressed.


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Case Study Whether to Help Ms. Li or Not!

Recently, Ms. Li has been suffering rheumatism because of the weather change. She feels joint pain, while getting dressed or bending down. The pain becomes even worse when she stands straight.

When Ms. Li’s daughter noticed it, she takes the responsibility of “taking care of” her mother. She tries to stay with her mom all day, and do every daily activity on behalf of her mom, such as changing clothes, picking up things, serving tea, shopping, and walking. She tells Ms. Li to sit all day to relieve joint pain.

On weekends, the elder son comes back home to visit their mom. However, he insists that Ms. Li should try her best to be independent. He even purchases assistance tools to help Ms. Li with activities that require bending, such as picking up things, getting dressed, and putting on shoes. He also tells Ms. Li that when shopping outside, she can use a trolley. Ms. Li’s daughter has a conflict with her brother because of this, saying “children should do everything for their mom as she becomes physically weak”. Ms. Li is in a dilemma because of different opinions from her son and daughter. All the neighbors, however, all agree that her daughter is more filial and considerate.

After reading this case, consider: 1. Is Ms. Li’s daughter providing proper care to her mom? Why? 2. How about her son’s method? 3. Considering the neighbors’ comments, what are the requirements for caregivers from general population? 4. Under the concept of “positive aging”, what roles should caregivers play to assist care recipients have a positive aging? _______________________________________________

_______________________________________________

_______________________________________________


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When challenging things happen, emotional health lets you bounce back and move on. Most of us take emotional health for granted and only focus on it when problems occur. However, like physical health, emotional health requires attention to build and maintain. A Caregiver’s emotional health is very important. Chronic stress that doesn’t go away can lead to health problems. There are many different tools that can help you achieve balance in your life, with time to relax, enjoy relationships, work and have fun. Methods listed below are effective systems to help caregivers face stress and problems. Seek Support and Build a Supportive Network Sometimes Caregivers have a difficult time saying they need help. They’re expected to be, or expect themselves to be, the strong ones, taking care of others’ needs. But one of the best things a caregiver can do to maintain emotional health is to ask for help. There’s no shame in letting others know that you need assistance. Learn to accept others’ assistance when it is appropriate. You can list things that require assistance from others before you seek help.

You can contact families, friends and neighbors who can provide assistance, and understand how to maximize the help from communities and seek formal assistance, thus to expand the supporting network (We will discuss in detail in Session 4). 1. Communicate frequently with families

² Share knowledge about diseases and care skills with family members, so that you can share the responsibility in providing care. Encourage families to participate.

2. Reach Out to Social Contacts ² A five-minute break to touch base with a compassionate friend, relative or

neighbor, even by phone, or e-mail can lift your spirits. ² Caregiving can be isolating. Keeping social contacts helps a lot in staying well.

Hearing the sound of others’ voices, reading their supportive words, or sharing thoughts with a kindred spirit requires only a short time in a busy caregiving day. Yet, this regular contact maintains your social support network.

3. Get some respite ² Respite means having someone stand in for you so that you can take a break.

Stepping away from caregiving for an hour or two, a full day or a week can help to relieve stress and restore your sense of well-being, when you know that the

Guidance for Caregivers


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care recipient is in good hands during your absence (Please refer to Unit 26 for more information).

4. Communicate with other caregivers

² Participate in support groups to communicate with other caregivers, share your experiences about providing care, and support each other psychologically. Support groups are safe havens for exploring and expressing grief, fear, guilt, anger and loss, joys and sharing coping skills. They are also great places to exchange caregiving resources. A social worker or other professionals often lead the group.

² Individual psychological counseling provides crucial support for some caregivers. Many caregivers find the combination of attending a support group and getting private counseling helps a lot in managing stress.

Build up Self-Care and Self-Management Skills 1. Self-care

² Remind and ask yourselves constantly whether you can keep up with the work, both physically and mentally. Have regular breaks every day. If you feel continually anxious, agitated, depressed, or pressured, you should take immediate action to seek proper help. Do not isolate yourselves.

2. Set a limit for yourself ² Understand your own abilities and limitations. Seek help when necessary.

3. Treat yourself ² For example, take some time with your friends to go shopping, or have afternoon

tea to “re-charge” yourself. 4. Self-education

² Learn about health problems related to care recipients and gain the skills needed in order to enhance confidence in providing care.

5. Plan ahead. ² Caregivers tend to neglect the importance of planning, because they are doing

the same routine every day. However, good planning can save time and efforts, and prevent risks from happening. For example, if an older person has physical limitation and needs wheelchair, the caregiver should plan the trip in advance and prepare the accessible transportation, in order to avoid fall accidents.

6. Reflect regularly ² Try to reflect on your care work regularly, so that you can review past events and

make improvements in the future. Stress Relief Techniques for Caregivers


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As mentioned above, in-home caregivers face more stress. However, even employed caregivers also feel stressed at work. Therefore, it is necessary to learn how to relieve stress. 1. Physical health

² Learn how to maintain physical health, so caregiving, especially when required to provide intense physical work can occur safely.

2. Psychological health

² Maintain a sense of humor, and avoid arguing with care recipients. ² If working at a nursing home, caregivers should form a support group to assist

each other, and share their experience. ² Do relaxation activities regularly.

3. Work settings

² Keep the work settings safe to reduce accidents. ² Play relaxing music to relive stress

Learning Activity Relaxation Practice

1. Find a place away from distractions, for example, your bedroom, or asked not to be disturbed.

2. Find a chair with back and armrest. Sit comfortably with feet touching the floor. Then close your eyes.

3. Keep your body in a relaxing position. Focus on your breath. Breathe slowly, evenly and naturally. While inhaling, silently count ‘one, three, five, seven, nine, stop’. Then exhale, counting ‘two, four, six, eight, ten, stop’. Repeat breath practice.

4. After your breath become balanced and regular, try to clench your fist then relax. Now you are in a relaxing mode.

5. Practice relaxation step by step. Usually starting from feet. Tighten your feet muscle and relax, keep relaxed. Then move to your calf, tighten and relax. Do the same thing for thighs, butts, hands, neck, face, and head, until you are fully relaxed. You can repeat each part multiple times.

6. It is enough to do relaxation practice for 15 minutes each time. Return to normal slowly after completion.

7. It will be beneficial if you can do it once every day. After you are familiar with it, you can do it whenever you want, but remember not to do it within two hours after meals.


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Although there can be a lot of stress as mentioned above, researches have shown that many in-home caregivers feel satisfied and a sense of accomplishment. For example:

² Build new relationship or enhance relationship with care recipients. ² Opportunities to give back: this usually applies to caregivers taking care of their

elder parents. ² Sense of success: although most in-home caregivers have not received formal

trainings, they can still face and overcome different challenges, making them feel a sense of accomplishment.

² Improve emotional connection with care recipients. ² Self-growth. ² Build new relationships with others through participating in support groups. ² Memories: although caring work is labor-intensive, it brings caregivers

memorable experiences.

Benefits for Caregivers

Self-Reflection

1. What role do you think caregivers should play?

2. Recall your own experience, what are the differences between actual role of caregivers and that suggested in this unit? What lead(s) to these differences? How to minimize the conflicts?

3. How should caregivers:

a. Evaluate their stress? b. Relieve stress? Do the suggestions in this unit only apply theoretically?

What are the difficulties in practicing the suggestions?

4. What benefits do caregivers gain?


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What is a Holistic Body-Mind-Spirit Model in Health?

Mental/Emotional health

Peace and awareness of mind, Accepting

positive and negative emotion, Mind

relaxation, Harmony relationship

Spiritual Life Meaning of life, Hope,

Spiritual peace and satisfaction, Appreciation, Acceptance, Forgiveness,

Self-completeness, Connection with nature

Physical Health Healthy diet, Free body and mind, Acceptance of

physical limitation

Goal setting, Pursuit of meaning, Self-

admiring, Perception of life, Here and now

Stillness/Meditation, Expressing emotion,

Development of a kind heart, Positive interpersonal relationships

Dietary therapy, Breathing exercise, Qi

Gong, Appropriate exercise, Massage and manipulation

Spirit

Mind Body

A Body-Mind-Spirit Model in Health


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Characteristics of the Body-Mind-Spirit Model The Body-Mind-Spirit Model in Health (BMS Model) incorporates philosophical

thoughts from Confucianism, Daoism, Buddhism into a view of life, health and intervention ideas. It also includes unique methods of self-cultivation and health preservation from traditional Chinese medicine, as well as concepts from western counseling psychology.

The BMS Model emphasizes seeing body, mind, and spirit as three parts in a whole circle, with a relationship of reciprocal coordination among these three parts. The key words “body,” “mind,” and “spirit” refer to the physical body, mental status (mainly in emotions), and spirituality (such as meaning of life, value of life, spiritual activities, spiritual self-care). The model pays attention to the positive development and balance of these three parts, and aims to achieve holistic health.

The Origin of the BMS Model

The concept of a “whole person” originates from Daoism. The “dao” refers to the way or nature, meaning the origin of universe. This idea forms the basis of Daoist thoughts. In addition, the Daoist philosophy/way of thinking (which come from Lao Zi) proposes that all changes adhere to two principles: “misfortunes and blessing accompany each other,” and “the extremity reached, the course will be reversed.” These two principles support the notion that “objects regulate one another.”

Traditional Chinese medicine theory believes that each organ of a person can differentially influence one’s mental state (moods). When a certain organ gets stimulation, it will result in a specific emotional expression. According to Neijing (a medical book), “There are five organs bringing five kinds of Qi in people, each causing a different reaction, and therefore triggering anger, happiness, anxiety, sadness, or fear.” “Liver controls anger, heart controls happiness, spleen controls anxiety, lung controls sadness, and kidney causes fear.

Meanwhile, a change in emotions can affect the organs and health of the body.”

Confucianism and Buddhism thoughts see “spiritual” development as a guiding principle. The domain of “spirituality” is not limited to that of religion and religious activities, but also includes self-awareness, the meaning of

life experience and life direction, peace of mind, and development of virtues (acceptance, letting go, forgiveness, etc.). Buddhism says that there are pains in life that are

unavoidable, such as illness and death. However, the pain caused by our emphasis on


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people, objects, thoughts and feelings can be avoided. Buddhism points out that spiritual pain originates from refusing to accept that all things are subject to change and we have limited power over changes. As long as we raise our awareness of and desire for control, view imperfection with an accepting and kind heart, and notice the good things around us, we can attain spiritual peace.

Clapping Procedure Introduction:

There are twelve channels in our body, and six of them are in our hands, including the heart channel, lung channel, pericardium channel, large intestinal channel, small intestinal channel and Sanjiao channel. The force generated through the clapping procedure can penetrate the six hand channels and improve the blood flow through these channels. There are many related acupuncture points on our hands. The clapping procedure uses slapping hands together as a means to open up six channels and enhance breathing and circulation. The clapping procedure is also significantly beneficial for improving one’s emotions and mental state, strengthening the body, boosting immunity, and helping prevent both chronic and acute diseases.

Exercise instructions:

1. Put both hands in front of your chest, point all fingers upward (as in the figure

above with both hands together); open your arms up to the shoulder width, and then tightly press all fingers together and clap with strength. Repeat the process for five minutes, and do the exercise three times each day.

2. After finishing the clapping exercise, spend some time doing the Qi practice (as in the figure below):

Exercises 1: Clapping Procedure, Waist Rotation and Shoulder Patting, Ten Hand Exercises


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a. Rub both hands until your palms are hot, and then place them on your lower abdomen

b. Separate your hands to the shoulder width apart, and then pay attention to them

3. You may choose one of the following ways to end the clapping procedure:

a. Rub both hands until your palms are hot, and then place them on your lower abdomen. Close your eyes and rest for a short while, allowing both your body and mind to relax.

b. Rub both hands until your palms are hot, and then place them on any tensed body part. Use soft touch to allow your body to relax.

Waist Rotation and Shoulder Patting Introduction:

Waist rotation and shoulder patting is a warm-up exercise in Tai Chi. In general, kidneys are located near the waist, so rotating the waist and spine can strengthen the waist and kidneys as well as prevent lumbar muscle strain. Another benefit is that it can improve one’s emotions. Traditional Chinese physicians believe that only through “reducing the heart fire, warming up the kidney water; increasing the kidney water, moisturizing the heart fire” can we balance and unify the body functions. Waist rotation and shoulder patting can strengthen the connection and regulate the function of the heart and kidneys, causing one to feel fresh and unrestrained. In addition, city dwellers generally do not exercise the waist muscles often, causing fat to accumulate in the waist, which can easily lead to gastrointestinal discomfort, and other related digestive problems. Waist rotation and shoulder patting also indirectly allow us to massage the digestive organs inside the body, stimulating the blood circulation and thus improving one’s digestion.

Exercise instructions:


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1. When beginning the exercise, separate your legs to shoulder width and stand

firmly. Relax your shoulders, and allow your hands to drop down to the sides of your body.

2. In the entire patting process, rely solely on the rotation of your waist to drive the movement of your hands, making them pat your shoulder and the back of your waist.

a. When rotating your body to the right, turn your head to the right; use your left hand to pat your right shoulder and use your right hand to pat the back of your waist

b. When rotating your body to the left, turn your head to the left; use your right hand to pat your left shoulder and use your left hand to pat the back of your waist

3. During the entire process, balance your weight upon your feet and your heels, keeping a balanced pose with both legs shoulder width apart.

Arm swinging procedure Introduction:

The arm swinging procedure is adapted from the “changing tendon classic (yijinjing).” The advantage of this procedure is that it is simple to learn and easy to practice. “Changing tendon” indicates that it will strengthen weak tendons and make the “sick” tendons stronger. In other words, this procedure is fitting and beneficial for both healthy and ill people. This procedure requires us to concurrently stretch the twelve channels in our fingers, palms, wrists, toes, feet, ankle, and knees. This causes the channels to extend and contract, which can increase the strength and health of one’s tendons. The arm swinging procedure can also improve the blood circulation of the body. Traditional Chinese medicine believes that the Qi and blood of the body are closely related to a person’s health; whether one is healthy or not depends on their flow being unimpeded. From the perspective of western medical knowledge, the circulation of blood has a close relationship to the entire physiology of a person. The arm swinging procedure takes advantage of the power of the arms to expand the chest and lungs, improve blood circulation, and facilitate regeneration and soothe the overworked body.


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Exercise Instructions:

1. Before the exercise, stand straight and look forward. Spread your feet shoulder

width apart, and let your toes hold firmly to the ground. 2. When beginning the exercise, slightly bend your knees forward (in order to

protect your knees, make sure they do not bend past the tip of your feet). 3. Raise both arms slowly to the height of the shoulder, and then swing your arms

backwards with some force. Then, let your arms get back to its original motion through moving it as if your arm was the pendulum of a clock. During the whole swinging exercise, keep your arms straight and do not bend them.

References: 1. The Salvation Army. (n.d.). Special Care: A Handbook for Family Caregivers of Older Adults [非一般的照顾：家庭照顾者手册], p.26. 2. Wan, H.Y. (2017). Caring for body, mind, and spirit: A caregivers’ handbook of exercises of body-mind-spirit model in health [关爱身心灵：身心灵健康自助手册]. Hong Kong: The Department of Social Work and Social Administration/ Center on Behavior Health, Hong Kong University.

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