How This Budget Cares

by Audrey Miller on March 27, 2017

in Uncategorized

Originally posted @allaboutestates.ca

Caring for our loved ones while satisfying and fulfilling can be expensive both emotionally and financially. Understanding needs, costs and tax relief are all important to saving money. Today’s blog provides some caring highlights from the 2017 Federal Budget.

1. Three current tax credits have been replaced with the proposed Canada Caregiver Credit. This non refundable credit applies to caregivers whether or not they live with their family member, and help with families with caregiving responsibilities.

The budget highlight below, which is quoted from the Government of Canada website provides the following easy to understand description:

Current Credits

Infirm Dependant Credit

Income phase-out range: $6,902-$13,785
Maximum credit amount: $6,883

Caregiver Credit

Income phase-out range: $16,163-$20,895
(for persons with infirmities/disabilities: $16,163-$23,045)
Maximum credit amount: $4,732 (if infirm $6,882)

Family Caregiver Tax Credit

Income phase-out range: variable
Maximum credit amount: $2,150

Proposed New Credit

Canada Caregiver Credit:

Income phase-out range: $16,163-$23,046
Maximum credit amount:

$6,883 for care expenses of dependent relatives including parents, siblings, adult children and other specific relatives.
$2,150 in respect of expenses for spouses/common-law partners and minor children

2. Another change is that Nurse practitioners can now certify application forms for people applying for the disability tax credit.

3. As well, there is a new Employment Insurance caregiving benefit which is for those who are caring for a family member with any serious illness or injury. It offers 15 weeks of leave from work at 55 per cent salary. Previously the benefit was intended for those with a family member near the end of life.

Steps in the right direction, now caregivers continue to wait for Bill C-233: A National Strategy on Alzheimer’s Disease and Other Dementias which by the way, is at the Senate at first reading.

Originally posted @allaboutestates.ca

Further to my colleague Diane Vieira’s March 15, 2017 blog, in which she summarized the Law Commission of Ontario report on legal capacity, decision-making and guardianship in Ontario, I wanted to highlight some key recommendations that I found to be particularly relevant. Over the last while, I have noticed a few changes including:
*Many of our older clients have outlived their family and friends
*We are also seeing an increase in dementia
*Many of these individuals do not have a POA for personal care
*If they do have a POA for care, this attorney is often not living closeby.

I work regularly with financial organizations and their estates division that hold the POA for property on behalf of their client. As was noted in the report: “Trust companies pointed out that they not infrequently found themselves acting as a property decision-maker without anyone at all to consult regarding personal care issues, and identified this as a significant challenge in achieving the overall goals of the legislation.” I concur. While I always assume capacity unless advised otherwise, there are many situations when capacity may be questionable. It is in these situations when direction and approval from a substitute decision maker is needed.

The Report identified “the growing number of businesses providing “elder care planning”, “transition planning” or “seniors care management” services. These businesses may assist individuals or their families in developing and monitoring care plans; navigating the health, long- term care or community services systems and assisting with accessing services; providing counselling or advice where difficult choices must be made (for example, whether to move to long-term care or remain in the community); and providing practical supports to carry out decisions.” Absolutely care managers can play a critical role in ensuring the older individual is living as well as they can by identifying what is needed, how much it costs, what other options exist and whether the expenditure will be ongoing. However, we are not the decision makers.
In terms of finding/designating a decision maker, “the LCO also believes that it is worthwhile to work towards developing a licensing and regulatory regime for professional, for-profit substitute decision-makers. These measures would expand the appropriate options for individuals, reduce the risks of abuse from unregulated options, respond to demographic trends affecting the availability of family members as substitute decision-makers, reduce the “personal care gap”, and more effectively focus the mandate and resources of the Public Guardian and Trustee.”

Another good idea and I look forward to seeing how this unfolds and whether it would be as a branch of the PGT or as a separate stand alone organization. Being a POA for care is a big responsibility. In addition to the recommendation of appointing a Monitor to oversee the attorney’s actions, and providing training to allied professionals, I can also see the need to provide orientation and training to newly appointed POA’s prior to signing a ‘Statement of Commitment’.

Our landscape is changing and our laws and policies should reflect the needs of our aging society.

Originally published @allaboutestates.ca

A complimentary copy of the Saturday Star was delivered to my door so I had the pleasure of holding a newspaper in my hand while enjoying my morning coffee (note: we have gone ‘paperless’ and I am not a happy convert). The headlines grabbed my attention: ‘Nursing homes feed seniors on $8.33 a day’.

This is not very much money- especially as I calculated the cost of my Nespresso ($.75) and croissant ($3.00). Healthy food is required by all of us- regardless of age. Much of our social society is built around meal times and the ability to engage and interact with others while enjoying a good meal. Not all of us have the ability to live out our days in our own homes. In December 2015 there were 76,982 long-stay patient beds(1).

For these individuals living in LTC, going to the dining room for a meal may be their only ‘out of room’ activity and for many, it is the highlight of their day. The newspaper article also discussed the lack of culturally appropriate or comfort food that is currently available in most facilities- due to this low budget. Most critically, the Dieticians of Canada in a 2015 report identified the lack of fresh fruit and vegetables available to residents. The number 1 response of the dieticians in this survey when asked “if you had additional funds for the raw food budget, what changes would you make to your menu or food purchases” was ‘improved proteins’. A sad headline I thought, while washing the newsprint off of my hands.

Ps. I was curious about the provincial funding (2)for long-term care in Ontario and have included it below:
– $4.07 billion (7.9% of the overall provincial health budget)
– $142.47 per resident, per day ($52,000 per year)
– Approximately $94.37 per day for nursing and personal care (such as assistance with personal hygiene, bathing, eating, and toileting)
– $11.60 per day for specialized therapies, recreational programs, and support services
– $8.33 per day for raw food (ingredients used to prepare meals)

1. http://www.oltca.com/oltca/OLTCA/LongTermCare/OLTCA/Public/LongTermCare/FactsFigures.aspx#/Ontario%27s%20long-term%20care%20residents%20(2015)
2. Source: 2016 Ontario Budget, LTCH Level-of-Care Per Diem Funding Summary (July 1, 2016)

Originally posted @allaboutestates.ca

Who knew spending the weekend immersed in dementia concepts could be so stimulating!!!
I spent the weekend meeting wonderful people, learning new definitions/concepts and a new language such as ‘repositories, source code/asset archives Full-Stack C# developer Java C#, C ++. Python, PHP, SQL’.
In return, I shared the concerns and challenge that I see working with those with dementia and their family caregivers at the amazing DementiaHackathon. The goal of dementiahack is “to enable the development of life-improving products that’ll make the world a little lighter for those affected by dementia — today”.

I spent the weekend talking with over 300 creative, thoughtful and amazing participants (majority in their 20’s) who spent an intense 30 hours (yes, working overnight!) developing an idea and prototype that will improve the lives of those with dementia and those around who love and care for them.
Sponsor Jordan Banks, (Face Book Canada Managing Director ) kicked off the event with the inspiration to be ‘Be Bold’ and Make An Impact’ while Kevin McGurgan, (British Consul General and Director-General for the Department for International Trade in Canada) advised that 1 in 3 residents in the UK either know someone or have been directly impacted by dementia. We know closer to home that we are still working on a Canadian and Ontario Dementia Strategy and we still have no cure for a disease, which I believe is becoming our biggest health challenge.

Mentoring on Saturday was stimulating and amazing. The participants’ enthusiasm charged the entire Mars auditorium. Choosing the semi finalists was no easy task and I was amazed and excited by the wonderful and thoughtful applications presented, ranging from memory reminders, environmental sensors, arts applications, wandering and safety applications, mental health and caregiver burnout trackers, early detection systems, diagnostic tools, and caregiver tracking and planning devices.
The grand prize winning team was ‘Momentum’ and their product ‘Memo’ which is a personal assistant that ‘collects and analyzes patient data through natural voice which will enable researchers to track the patient’s progress through the result of Memo’.

An inspiring weekend and I very much look forward to seeing many of these applications be available in the market place soon! We are the ones who will benefit from many of these thoughtful designs and in my opinion we are all winners.

“Yesterday, we lost a giant – an exceptionally creative scientist and engineer who was also a delightful human being. Millie Dresselhaus began life as the child of poor Polish immigrants in the Bronx; by the end, she was Institute Professor Emerita, the highest distinction awarded by the MIT faculty. A physicist, materials scientist and electrical engineer, she was known as the “Queen of Carbon” because her work paved the way for much of today’s carbon-based nanotechnology.’ In 2014, Millie won the Presidential Medal of Freedom, the highest civilian honor in the United States. I believe she earned this distinction because the way that she led her life in science represented citizenship in the highest sense.”(Excerpt from MITNEWS President L. Rafael Reif, Feb21, 2017.)

Only a few days before her death, GE produced a commercial titled “What if female scientists were celebrities?” profiling Millie as a role model promoting and encouraging women to pursue science and technical roles. This video will be a lasting legacy for the general public who otherwise would not know this remarkable woman.

I did not know Millie as a scientist nor was I conversant in her work with carbon based nanotechnology. I did however know her as a mother and grandmother who raised her family to be strong and search out and pursue their dreams. I know she was at her lab last Monday doing science and one week later, she passed away. While the scientific community has lost a renowned physicist, my sympathies are directed to the Dresselhaus family who has lost their mother (and inlaw), wife and grandmother.

With a view on the Oscars this weekend, Healthwick Canada, a supplier of incontinence products wrote a blog called ‘Celebrities With Incontinence’.

Now, having urinary incontinence is not something that most of us want to shout from the mountain tops. However, it is more common that you might think. According to the Canadian Continence Foundation over 3.3 million Canadians experience incontinence. Incontinence is defined as ‘the involuntary release of urine at the wrong time and/or place’. Twenty five percent of middle aged or older women have it as do 15% of all men aged 60 and older while 90% of seniors living in a long term care facility are affected. There are several different types of incontinence and all have different causes. It is not caused by aging but ‘changes which occur with the natural aging process may contribute to incontinence’, such as enlarged prostate or loss of estrogen and weakness in the pelvic floor post child birth.

Many of us have experienced that particular sensation, after coughing, sneezing, laughing or playing sports. The good news is that it is usually treatable and therapies can include non medical treatment such as kegel exercises or pelvic floor muscle training, bladder training and diet as well as medical interventions ranging from injections to surgery.

Today, incontinent products are common place. While I personally don’t like the term adult diaper, I coined ‘adpers’ so there is no shame when asking the grocery store clerk where the adult incontinence products are displayed.

We are in good company with Kate Winslet, Samuel L. Jackson, Katy Perry, Marie Osmond and several others who have publicly shared their experience with incontinence. You know their secret so watch for them at the Academy Awards this Sunday.

Originally posted @allaboutestates.ca

I recently had the pleasure of listening to Dr. Danielle Martin address health care system challenges faced by Canadians daily. In her book Better Now, Dr. Martin explores ways to make Canadian health care better. Dr. Martin is a family doctor and practices in the Family Practice Health Centre at Women’s College Hospital where she is also the Vice-President of Medical Affairs & Health System Solutions. Her 6 main ideas include:

Big idea#1: Ensure relationship-based primary health care for every Canadian (talking and connecting with your doctor and electronic sharing of info);

Big Idea # 2: Bring prescription drugs under Medicare (we pay too much and many do without all together);

Big Idea # 3: Reduce unnecessary tests & interventions (does 95 yr old mom need that biopsy?);

Big Idea # 4: Reorganize health care delivery to reduce wait times and improve quality ( how long does it take to see a specialist? New survey says on average Canadians wait 20 weeks for ‘medically necessary’ treatments in 2016);

Big Idea # 5: Implement a basic income guarantee ( poverty can make you sick);

Big Idea # 6: Scale up successful solutions across the country (doing what works);

Certainly not all of these ideas are new. What’s new is that they are been thoughtfully described based on her and of those around her, own experiences. What I didn’t get to ask her that night was her vision on what a dementia strategy would look like and how we can be better prepared to address the needs of all of us as an aging society.

Good mental health is important. A few weeks ago was Bell Canada’s ‘Let’s Talk Day’ which was about raising awareness and money for mental health improvement. This year, Bell Canada had 131,705,010 interactions from people like you and me either tweeting, calling, posting on Instagram, viewing a Facebook video or texting on January 25, all raising awareness of mental health issues. For each of these interactions, Bell donated .5 cents raising $6,585,250 for mental health awareness and programs across Canada.

Bell Let’s Talk “promotes awareness and action with a strategy built on 4 key pillars: fighting the stigma, improving access to care, supporting world-class research and leading by example in workplace mental health.” One in five Canadians will suffer from mental illness at some point. The information provided @ letstalk.bell.ca shares that one of the biggest hurdles and why 2/3 of those living with mental illness don’t seek help, is because of the stigma associated with it.

While all of the pillars identified are important, I thought I would highlight the anti- stigma pillar as the theme today as I hear derogatory terms tossed about way too often, that can have serious impact on someone’s well being. Awareness is about understanding and knowing the difference between facts and myths. We learn at a very young age that words can hurt; using proper terminology and avoiding terms like ‘crazy or nuts’ is part of it.

Mental illness is more than having the Monday Blues, or a bad day; telling someone that they will get over it or they should think about something else, is not helpful. Asking, listening and understanding are ways to help support someone who may be clinically depressed, whether or not they have yet have been diagnosed. It helps to show the other person that you care and they are not alone.

Depression is not a normal part of aging. Grief and loss can result in sadness. Clinical depression is something else. While it is difficult to talk about mental illness, it is important to do so and acknowledge the challenges that someone is facing. Bell created a conversation guide and I have attached their link.

How are you feeling today? Remember to have your Check Up From The Neck Up.

Ontario’s Dementia Strategy

by Audrey Miller on January 30, 2017

in Articles & Blogs by Audrey, Dementia

Originally posted @allaboutestates.ca

Over the last many years I have shared many blogs on the crisis of dementia. It is a disease that impacts everyone and with science helping us to live longer, we need to appreciate that for some, they may feel that they are not living at all. I have discussed both the economic and financial cost to providing care to a loved one with dementia that impacts our work, our lives, our health care system and our economy. Last week’s blog highlighted recommendations from the Standing Senate Committee on Social Affairs, Science and Technology titled: Canadian Dementia in Canada: Developing A National Strategy for Dementia-friendly Communities.
Today’s blog highlights Ontario’s discussion paper on developing a dementia strategy, with the goal to “ensure that people with dementia and their care partners:
-are treated with respect;
– have access to information that allows them to make the best possible choices regarding their health and well-being; and
-are living well with dementia, helped by appropriate services and supports where and when they need them.”
Let’s start with the bad news:
“It is estimated that about 228,000 Ontarians are living with dementia. As Ontario’s population ages, it is expected that these numbers will rise to 255,000 people in 2020 and over 430,000 people by 2038.” The Ministry of Health and Long Term Care project that between “2008 and 2038, dementia is projected to cost Ontario close to $325 billion.”

So what’s the good news? Well we are making some progress. Through a consultation process, six themes have been identified that should hopefully guide a Provincial dementia strategy. These themes include:
“-supports for people living with dementia;
-accessing dementia services;
-coordinated care;
-supports for care partners;
-well trained dementia workforce; and
-awareness, stigma and brain health”

Public consultations are now complete. The next phase is to see a fully funded dementia strategy included in the Ontario 2017 budget.

The best news? You can still get involved http://actionfordementia.ca

Originally posted @allaboutestates.ca

“I can think of no other disease that places such a heavy burden on families, communities, and societies. I can think of no other disease where innovation, including breakthrough discoveries to develop a cure, is so badly needed.”

— Margaret Chan, Director General, World Health Organization (Opening remarks at the First WHO Ministerial Conference on Global Action against Dementia, 17 March 2015)

As January is Alzheimer’s Awareness month, I thought it fitting to highlight recommendations made as part of the report completed in November 2016 by the Standing Senate Committee on Social Affairs, Science and Technology.

We have heard that several different things can increase the risk of dementia (most recently living near a busy highway) however we do know for certain that the primary risk factor for dementia is getting older. The Canadian Institute of Health Research provides that approximately 1 in every 3 persons over age 85 is likely to develop dementia. A National Strategy is needed and needed quickly.

Recommendations put forward by the committee include:

RECOMMENDATION 1: the federal government immediately establish the Canadian Partnership to Address Dementia with a mandate to create and implement a National Dementia Strategy.

RECOMMENDATION 2: The committee further recommends that the federal government, when establishing the Canadian Partnership to Address Dementia, take into consideration the structure and function of the Canadian Partnership Against Cancer, however the new organization must:-include representation from, but not be limited to, federal, provincial and territorial governments, dementia and other health-related organizations, individuals affected by dementia and their caregivers, healthcare professionals, housing organizations, researchers and the Indigenous community;-be required to evaluate, report on and update the strategy annually; and,-receive adequate federal funding of at least $30 million annually.

RECOMMENDATION 3: the federal government adjust the annual funding provided to the proposed Canadian Partnership to Address Dementia in response to annual evaluations and strategy updates.

RECOMMENDATION 4: the proposed Canadian Partnership to Address Dementia, in its development and creation of Canada’s National Dementia Strategy, be guided by

-the Alzheimer Society of Canada’s The Canadian Alzheimer’s Disease and Dementia Partnership: Strategic Objectives, and -Alzheimer’s Disease International’s report Improving Dementia Care Worldwide: Ideas and Advice on Developing and Implementing a National Dementia Plan.

RECOMMENDATION 5: the federal government allocate to the Canadian Institutes of Health Research’s Dementia Research Strategy, as a component of the proposed National Dementia Strategy, 1% of current direct dementia care costs, or approximately $100 million annually.

RECOMMENDATION 6: the Public Health Agency of Canada create and implement, within the National Dementia Strategy, a comprehensive public awareness campaign that includes promotion of the Dementia Friends Canada website as well as high-visibility/high-impact approaches regarding prevention, early diagnosis, symptom recognition, quality of life, and services and supports.

RECOMMENDATION 7: with respect to prevention strategies, the federal government implement recommendations 20 and 21 of the Standing Senate Committee on Social Affairs, Science and Technology’s 2016 report entitled Obesity in Canada: A Whole-of-Society Approach for a Healthier: report report entitled Obesity in Canada: A Whole-of-Society Approach for a Healthier Canada, by:-designing and implementing a public awareness campaign on healthy eating based on tested, simple messaging, and -implementing a comprehensive public awareness campaign on healthy active lifestyles in collaboration with other relevant departments, agencies, experts and trusted organizations.

RECOMMENDATION 8: the federal government ensure that Public Health Agency of Canada receive adequate resources for the Canadian Chronic Disease Surveillance Program so that it can provide robust, timely and accessible dementia surveillance data beginning in 2017.

RECOMMENDATION 9: the proposed Canadian Partnership to Address Dementia ensure that Canada’s National Dementia Strategy encourages the implementation of the Alzheimer Society of Canada’s First Link® early intervention program across Canada, adapted as necessary to be appropriate and culturally sensitive to each community.

RECOMMENDATION 10: the federal government explore fiscal options to reduce the financial stress on informal caregivers including:-expanding the Employment Insurance compassionate care benefit beyond palliative care; and,-amending the Caregiver Tax Credit and the Family Caregiver Tax Credit to make them refundable in order to benefit lower income Canadians.

RECOMMENDATION 11: the federal government promote the workplace best practices identified in the 2015 report commissioned by Employment and Social Development Canada entitled When Work and Caregiving Collide: How Employers Can Support Their Employees Who Are Caregivers.

RECOMMENDATION 12: the proposed Canadian Partnership to Address Dementia ensure that additional caregiver supports be promoted through the National Dementia Strategy including:-education and training;-respite services; and,-a web resource portal that provides access to information about these programs and initiatives.

RECOMMENDATION 13: the federal government provide, in the upcoming Health Accord, targeted funding of $3 billion over four years for a comprehensive package of home care services.

RECOMMENDATION 14: the federal government require that the targeted funding for home care services under the new Health Accord be subject to regular evaluation and reporting that demonstrates effective use of funds, which will provide the basis for annual, success-based adjustments to funding.

RECOMMENDATION 15: the federal government assess the need for home care funding beyond the initial four-year period as provincial budgets for health services and social services develop and implement integrated models of care.

RECOMMENDATION 16: the proposed Canadian Partnership to Address Dementia engage stakeholders in promoting innovative technologies and the Home-Care-Plus model that integrates specialists in dementia care into the home care model.

RECOMMENDATION 17: he federal government in collaboration with provincial and territorial counterparts:-assess the fiscal barriers currently preventing the integration of health and social services; and,-implement the necessary changes in order to facilitate the re-structuring necessary for integrating health and social services.

RECOMMENDATION 18: the federal government implement recommendation 1 of the Standing Senate Committee on Social Affairs, Science and Technology’s 2014 report Prescription Pharmaceuticals in Canada — Unintended Consequences, regarding:-establishing targets for the implementation of electronic health and prescription drug systems;-promoting the use of and accelerating the uptake of electronic databases by health professionals through an aggressive targeted awareness campaign; and,-public reporting on the progress of implementing electronic health and prescription drug systems.

RECOMMENDATION 19: the proposed Canadian Partnership to Address Dementia, within the National Dementia Strategy, promote:-models of dementia care that integrate healthcare delivery, such as the Dementia-plus Care Model;-integration of social services into dementia care; and,-a continuum of care that includes advance care planning for integrating of palliative and end-of-life care.

RECOMMENDATION 20: the federal government invest $540 million in continuing care infrastructure to increase the capacity for long-term care in provinces and territories.

RECOMMENDATION 21: the proposed Canadian Partnership to Address Dementia ensure that the National Dementia Strategy includes efforts to:-examine and update as necessary the staffing, care and accommodation standards applied to seniors’ residences, including legislation and regulations; and,-explore and assess a range of opportunities to improve access to seniors’ housing.

RECOMMENDATION 22: the proposed Canadian Partnership to Address Dementia include within the National Dementia Strategy the assessment and promotion of specific models of dementia care for rural and remote communities including that of Rural and Remote Memory Clinics.

RECOMMENDATION 23: the federal government expedite the funding of the new program to enhance high-speed broadband coverage throughout Canada.

RECOMMENDATION 24: he Home and Community Care Program, delivered by Health Canada’s First Nations and Inuit Health Branch:-be funded to reflect current Indigenous population levels; and, -permit and encourage innovative approaches to program delivery.

RECOMMENDATION 25: the proposed Canadian Partnership to Address Dementia work with Accreditation Canada, within the context of the National Dementia Strategy, to develop standards of dementia care for acute-care hospitals.

RECOMMENDATION 26: the proposed Canadian Partnership to Address Dementia, within the context of the National Dementia Strategy, in collaboration with provincial governments, medical faculties, nursing programs, and their regulatory and licensing bodies, address health human resource capacity, training and professional development with respect to aging and dementia care.

RECOMMENDATION 27: the proposed Canadian Partnership to Address Dementia ensure the development, implementation and promotion of a secure Best Practices Portal available to health and social service providers of dementia care.

RECOMMENDATION 28: the Canadian Partnership to Address Dementia consider the programs and practices listed in Appendix 1 for inclusion in the proposed Best Practices Portal.

RECOMMENDATION 29: the proposed Canadian Partnership to Address Dementia ensure that persons with dementia are included in all aspects of its work.

Great recommendations however we are not there yet. Future blogs will continue to update the progress of our elusive dementia strategy.