Reposted from


This original post was from a few years ago. It does seem like only yesterday because, while time has not stood still, sometimes our sentiments don’t change. The event and message is the same. It is a few years later and there is a new US golf champion. We still however miss those who are no longer around.

It was hard not to know that yesterday was Father’s Day. Signs, announcements and broadcasters made it very difficult not to acknowledge the day. Is it not odd that we need to be reminded by those organizations that typically want us to purchase something? Well maybe we do need to be reminded to spend a moment either with our fathers, if we still have one or to spend some time thinking about our fathers, for the rest of us. My father has been dead for almost 18 years and he died way too young from a ugly disease. Days do go by when I have not thought about him.The other day, I was out for lunch with a colleague and I bumped into a family friend from childhood who I had not seen for years. After briefly catching up, he was quick to remind me how close he was to my father and the impact he had made on his life. Years had passed since I had remembered the positive impact he had on others and on my friends who considered him a father figure as well. My father had an early death and there was much left undone and unsaid.

In my work with families dealing with their parents, I see those who may be flesh and blood but don’t like each other and who do not get along. In other families I am so touched by the care and respect that is shown and expressed. There is however a lot of grey in the middle. Perhaps the commercial reminder of Father’s Day can be the poke we need to reconnect and reaffirm with our own fathers so that we will not feel that there was much left undone or unsaid. Bumping into this old friend and being reminded of my father’s joie de vivre, brought a smile to my face.
Happy Father’s Day.

Keeping Memories Alive

by Audrey Miller on June 12, 2017

in Elder Care, End of Life

Originally posted

It is hard enough when a loved one forgets; but it is also very painful when family forget …. about who the older person is and who they were. Many times older people are seen as just that old folks- who may be wrinkled, forgetful, stooped over and hard of hearing. But what about all of their experiences, history, successes and accomplishments?

I wanted to highlight some remarkable women, whose stories today may be forgotten by almost everyone; women in the twilight of their years who may be alone having outlived family and friends. These are women who all made incredible contributions and led remarkable lives. Betty Rich is one such lady who is now in her late 90’s and only a few years ago chronicled her own story in a book called: Betty Rich: Little Girl Lost.

Mrs. Rich tells of her war experience in occupied Poland and the hardships that she faced under the Nazis. It is also her story about hope and perseverance and in her words, ‘how we deal with our fate’.
Other remarkable women whose stories may be forgotten include trailblazers in their own right. Women who pursued careers in medicine and accounting in the 1930’s and made tremendous sacrifices along the way; for several of them this meant having a career over family. Sometimes we don’t know the person for who they are on the ‘inside’ and may only see them for who they are today which sadly may be a decaying shell of their former self.

The axiom, ‘don’t judge a book by its cover’ is applicable. Lesson learnt: Get to know the person inside of the person you see.
Ps. on that note that are companies and apps that can help document someone’s story.

Elder Orphans

by Audrey Miller on June 5, 2017

in Baby Boomers, Elder Care

Originally posted

You may already be familiar with the terms. It refers to older individuals who do not have any family to provide care for them. They have either outlived their family or are estranged from them. With our aging demographics we are working with many single women who do not have any children.

Society has shifted and traditional models of care that were supported by nuclear and extended families and communities have changed. Our families are smaller, gender roles are shifting, more people seek full time employment to keep families financially stable. People are living longer, outliving their friends and families, and live further away from familial supports. Further, more people are choosing lifestyles other than the traditional nuclear family. This has added new challenges to caring and being cared for. Many talk about struggling to juggle the different pressures that modern life brings and how it impacts their capacity to care for those around them or to find the care that they need.

This can leave many feeling isolated and can seriously impact physical, mental and financial health of caregivers and those being cared for.

How we care for one another and planning for who cares for us is evolving. Many of us do not want to rely on the government to provide our care or make our care decisions. There is no one size fits all solution. Building communities and creative approaches will be critical. There have been several co housing initiatives that are/have started whereby like- minded individuals create their own communities.

The following articles touch on some of these challenges and solutions.
A recent Toronto Star article reflects on ‘all the single senior ladies’.

Radical Resthomes is a home grown movement out of Montreal. They have created a short documentary that outlines their plan.
Sonia Sodha considers the challenge of finding care and providing care for the childless. She suggests that “resolving the question of what the state can and ought to do is relatively easy compared with the much knottier problem of how to create a society that has an abundance of the things – love, companionship, emotional support – that the state can never hope to provide”. If you have no children, who will care for you when you’re old?

Golden Girls Here We Come!

Originally posted

I had the pleasure of recently attending the B’nai Brith Canada Estates and Trusts Group annual seminar, titled Power of Attorney Disputes. It was a wonderful opportunity to watch some of Ontario’s finest estate lawyers play different roles (feuding siblings and mediator) as well as hear their professional perspective on various aspects of Power of Attorney disputes regarding questionable capacity, accounting issues, estate trustees and sexual consent.
While the focus of most disputes has to do with money ( and likely the majority that proceed to trial) and the Power of Attorney for Property, my interest is with the disputes that occur on the care side and the Power of Attorney for Personal Care.

What I have seen in my many years working with caregiving families, which is paramount to the tension, is simply put, the lack of communication. The adult children’s hurt feelings of bygone years and perception seems to further cloud the situation. At the end of the day or perhaps it should really be at the beginning of the day, is the need to understand what the care issues actually are about. Understanding what the older individual actual care needs are and by having them properly assessed and documented, I believe can go a long way in reducing or maybe even eliminating the battle. Old hurts may not be resolved but the hope is that they can be put aside at least so they don’t interfere and impact the well being of the parent. Having siblings on the same page for a plan of care for their parent may be the answer.

Fellow blogger, Dr. Richard Shulman in his blog “The Psychology of Decision making by Attorneys for Personal Care – What You Won’t Learn in the Substitute Decisions Act (SDA)” shared his perspective on the psychology at play. He highlights the possibility of a previous estrangement or abandonment as well as guilt and hidden motivations (Mom loved you better or leave the money for my inheritance) that impact relationships and lead to these challenging disputes.

Understanding care needs from a medical and functional perspective is helpful at the beginning of the caregiving journey. Communicating these care needs to all involved and having an open discussion about ways to share the care or how the care will be provided and by whom and whether it will be monetarily compensated is worthy of further discussion, and may even be able to prevent an expensive trip to court.

Going Gently Into The Good Night

by Audrey Miller on May 15, 2017

in End of Life

Originally published

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

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 @

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

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.