Going Gently Into The Good Night

by Audrey Miller on May 15, 2017

in End of Life

Originally published @allaboutestates.ca

Last week was Canada’s National Hospice Palliative Care Week. So what is palliative care? Since its inception in Canada in the 1970’s, things have changed quite a bit. Only a few years ago, the term palliative care and the public’s general understanding, was that it meant the end was imminent and all proactive treatment was to be stopped. Patients would hear the term ‘palliative care’ and it would mean less care, and that accepting it meant doctors will stop trying to help.

Last year I blog on understanding palliative care as well. I shared a CBC interview with Dr. Brain Goldman in discussing that I felt a new name is needed. Well, there is no terminology but hopefully there will be a new understanding. The approach now is ‘living as comfortably as possible’ until death. For some, medical assistance in dying (MAID) may hasten the process. Regardless The Canadian Hospice Palliative Care Association shares that it is about ‘living well, right to the end’, whenever the end is.

There is still much stigma and misconception however generally in understanding what Palliative Care means. CBC Metro Morning’s Matt Galloway spoke with Dr. Desmond Leung, a palliative care doctor from North York General Hospital.

As Dr. Leung shared, we may fear death but the hope is we don’t have to fear the process leading to it. Supports and resources and care will continue to be provided to the patient and family. I will be meeting with Dr. Leung later this week when I attend a family meeting for my 97 year old client, who wants to go home so she can go gently into the good night- on her terms.

Originally posted @allaboutestates.ca

I am not a big fan of statistics but these figures are worth noting. Today there are more seniors over age 65 than children under age 14. Not only are we living longer but adults over 100 years of age are the fastest growing age group. Today’s life expectancy is 80 years for men and 84 years for women.
Good news if you are a single fellow. There are nearly twice as many older women (85 +) than men; and if you are over 100 years of age this ratio increases to 5:1.

According to the 2016 Census, these older seniors( aged 85+) represent 2.2% of the Canadian population. This number is still behind Japan which has 4% of its total population aged 85 and better. Hold on to your hat because when the youngest of these boomers reaches age 85 (in 2051), this will represent 5.7% of the Canadian population.

By 2031 almost 1 in 4 Canadians will be 65 years of age and older. Only a few years later we have been informed that by 2038, 2.8% of the Canadian population will have dementia. (Rising Tide: The Impact of Dementia on Canada 2010). In this same year “62% of Canadians (65+) with dementia will be living in their own homes and the total number of hours of informal care will more than triple, increasing from approximately 231 million hours in 2008, to 756 million hours.”

I hope you are paying attention to these numbers. This has implications for all of us. The demands on our resources and time will increase, including the demands on the family caregiver, the demands on the medical and health care systems will increase and the demand for appropriate housing will increase.

This latest census data tells us that there are fewer young people. I can only wonder who will be taking care of us and how are we going to be able to take care of each other?

Suicide and Seniors

by Audrey Miller on May 1, 2017

in Dementia, Elder Care, End of Life

Originally posted @ allaboutestates.ca

In last week’s blog, my colleague Dr. Shulman highlighted the ten ‘D’s of Geriatric Psychiatry . The ‘D’ that I would like to comment on today is depression which is closely linked to his last ‘D’ which is death. I have blogged over the years that contrary to popular belief, depression is not a normal part of the aging process.

The Canadian Association For Suicide Prevention reports that 10 seniors die by suicide every week and that men age 65 + are the ‘most at risk demographic.’ Risk factors from CASP include:
• Fatigue (difficulty falling asleep)
• Loss of interest in hobbies or pleasurable pastimes
• Social withdrawal and isolation
• Loss of self-worth
• Weight loss or loss of appetite
• Fixation on death

Getting older and losing close friends and family can be terribly difficult. Illness, loss of independence and outliving those you care about can certainly lead to depression. Feeling that there is no joy left and a continued sense of emptiness are risk indicators. Understanding these risk factors and helping someone to do something about them is key. CASP recommends reaching out to the individual, suggesting a change in routine, a new activity, involvement with others and helping them to find purpose. Counselling and medical treatment may also be needed.
As there are now more seniors than those under age 15, we need to be aware of each other. Technology can also assist. More and more seniors are ‘wired’ and on line support groups either in person or on line are positive initiatives.

Reach out and talk to someone- today.

Originally posted @allaboutestates.ca

In our busy day to day lives I have found that people will often use acronyms, assuming their listener/reader understands. This is not always the case. It is not only the younger generation that is using new terms (what exactly is a meme?), but those of us in the caregiving world also embrace our own jargon.

While I try to be cognizant of using proper names rather than acronyms or abbreviations, it is not always done. As such, I am attaching a link to a previously published ‘Terms to Know’ article which provides a list of frequently used terms and acronyms. While it is not exhaustive, it provides a good starting point.

Within the dementia specific community, there are a number of terms as well, including for the PLWD (Person Living With Dementia). I have attached this glossary of terms relating to alzheimers disease from the Cleveland Clinic.

Next time you get a prescription it may be helpful to know if it is to be taken p.o or p.r.

Power of Attorney Project

by Audrey Miller on April 20, 2017

in Podcasts

My interview on “Families Are Complicated and Necessary” as part of the Caregiving Matters Power of Attorney Project.

Holidays and Family Traditions

by Audrey Miller on April 19, 2017

in Articles & Blogs by Audrey

This past week we celebrated Passover and Easter. Major holidays recognized with a statutory holiday attached, at least for the latter. I wonder however about the observance of these holidays and whether this has waned over the years.

For me and perhaps for many of you, these holy days have a traditional familial connection rather than a religious one. The foods eaten, or perhaps the foods not eaten, while symbolic of a religious theme, also provide a familial custom. It is this connection and the lifelong memories associated with these annual holiday celebrations, which I believe remain with us. For me, it is the family gathering, the specialty foods and singing of songs that stay. I think for many with memory decline, this holds true as well. For those who lost a loved one, an empty seat at the holiday table can be particularly difficult.

For many, there is comfort in making a favorite holiday recipe that was previously made by a loved one who is no longer with us. While it may not taste the same, new traditions and new flavours can be welcomed as well. My husband and I were very fortunate this year to have my mother along with both of our sons join us and our new tradition included having additional extended family members join us who had not previously. I hope you too enjoyed a special Spring holiday season, however you celebrated.

Thank A Family Caregiver

by Audrey Miller on April 3, 2017

in Articles & Blogs by Audrey, Caregiving

Originally posted @allaboutestates.ca
Tomorrow April 4, 2017 is Ontario’s first annual Family Caregiver Day.

Family caregivers support the very fabric of our society. It is not only about caring for older adults as it includes anyone who is in need of assistance. The Oxford Dictionary defines ‘care’ as a “the provision of what is necessary for the health, welfare, maintenance, and protection of someone or something”. A broad term which encompasses caring for someone else, regardless of age or diagnosis.

The term ‘family’ according to the Oxford Dictionary is “a group consisting of two parents and their children living together as a unit.” Today I would suggest that this definition needs to be expanded. The Vanier Institute of the Family provides perhaps a more accurate description of the term ‘family’ based on what families do, rather than what they look like: Their definition includes: “Any combination of two or more persons who are bound together over time by ties of mutual consent, birth and/or adoption or placement and who, together, assume responsibilities for variant combinations of some of the following:

Physical maintenance and care of group members
Addition of new members through procreation or adoption
Socialization of children
Social control of members
Production, consumption, distribution of goods and services
Affective nurturance – love”

Their definition is inclusive of diverse family structures and includes a relationship between an adult and another person, over time, ‘signifying that a commitment has been made.’

The General Social Survey in 2012, identified that 30 % of all Canadian women reported providing care closely followed by their male counterparts at 26% of all men.

Family caregivers of seniors specifically have been identified as saving our Canadian health and community service systems $31 Billion annually. While advances have been made with caregiving robots and technology, family caregivers are not easily replaceable. The worry of course is that we are top heavy. There are now more seniors over age 65 than those under age 15. A recognized Caregiver Day is not much but it is a start.

Today, tomorrow and every day, is a good day to say thank you to the Family Caregivers you know.

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)