Caregiving for the Long Haul: Think Small


Tsgoyna Tanzman

Tsgoyna’s presentation, titled “Caregiving for the Long Haul: Think Small” focused on caregivers making small shifts in developing routines, improving organization, and defining the best version of self-care.


“Routines create stability and predictability,” Tsgoyna said. “The human body craves routine. We don’t want every day to be exactly the same because too much certainty leads to boredom, but caregivers who implement routines tend to thrive, while those who don’t struggle. Established routines can reduce decision fatigue and create a less stressful environment.”

  • A Menu of Activities: Leaving the calendar open without scheduled activities leads to negotiation issues and cognitive fatigue. Create a menu with necessary and fun activities to anchor your day. Tsgoyna said, “At a restaurant, you open the menu to decide what to eat.” Present your loved one with your menu of activities—cognitive, leisure, spiritual, physical—and say, “On Tuesday, do you want to go to the park or work on word puzzles?” This helps anchor activities between appointments.
  • Scheduling Blocks of Time: Allocate specific blocks of time for tasks and ensure necessary downtime or transition time between them. For instance, establish a routine for bathing. Instead of battling with your loved one, decide that bathing will occur weekly on Tuesdays at 11 AM. This predictability helps avoid conflicts.
  • Handling Bathing Resistance: If bathing is a battle, try to understand the resistance. The room or water temperature might be too cold or hot. The person might feel unsafe if the space is too large or the shower chair doesn’t feel stable. Handling the person with the right touch and speed can influence their sense of safety. Use warm towels if possible. If bathing is still resisted, consider using Scrubzz rinse-free sponges, which do a great job of cleaning and leave the skin refreshed. These come in lavender and non-scented varieties and are available on Amazon.
    “If you want to achieve something, you must plan and schedule it to make it happen,” said Tsgoyna. It’s imperative to know your WHY for planned activities. For instance, if you have a 20-minute walk scheduled on Wednesday, remind yourself why you’re doing it—perhaps to gain more stamina for caregiving. “There are 365 days on the calendar, and not one of them says ‘some day,’” Tsgoyna noted.
  • Habit Stacking: This involves stacking a new habit onto an existing one. For example, to improve balance, practice standing on one leg for 30 seconds while brushing your teeth. “If you do this daily, you’ll spend 22.4 hours a year working on your balance. Small changes add up like compound interest,” Tsgoyna said.


The biggest time waste comes from looking for misplaced items. Creating zones in your home for different purposes frees up time.

  • Create ZONES: Make a medical zone to include all the things you routinely need. For example, med boxes, blood pressure cuffs, glucometer, journals, and pens/pencils. Consider using the Caregivers Journal and Workbook to track blood pressure and sugar so you have recorded data for a month in one place. This data will help you talk with doctors if medications need to be changed.
    Use this strategy for personal goals too. If you plan to exercise in the morning, set your intention the night before and have your exercise gear laid out in one place (its own zone).


“Begin to think of yourself—the caregiver—as the asset,” says Tsgoyna. If you do for the stroke survivor what they can do themselves, you may create learned dependence.• Self-Care Audit: Tsgoyna recommends that caregivers do a self-care audit to identify what they can do for themselves. Caregivers often feel overwhelmed and may neglect their own needs. One self-care activity is focused breathing: 4 seconds in, hold for 4 seconds, and 4 seconds out. “Breathing consciously can help regulate your nervous system,” Tsgoyna said.

  • Identify True Self-Care: Determine what true self-care means for you. It might be reading a novel for 15 uninterrupted minutes or scheduling a phone call with a friend. “If someone offered you a million dollars to make time for self-care, could you find a way?” Tsgoyna asked.
    Caregivers who neglect self-care may feel overwhelmed and angry, leading to shame and guilt. “We have to make space for grace for ourselves,” Tsgoyna emphasized. “You can’t drive from CA to NY without stopping for gas.”

Tsgoyna concluded her presentation with this: “Take a look at Routine, Organization, and Self-Care, and think small—really small. Don’t try to do everything at once. Implement one small habit today that can become routine over time. You are the asset. Once you start thinking that way, you’ll feel and act differently.”

Caregiver Quiz
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