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.

Originally posted @allaboutestates.ca

After 70 years of marriage Norman and Mae are told by our government that in order to get the care they need, they need to live separately. Certainly there is something not right about this statement, yet as hard as it is to believe, that was the story reported in the National Post on Jan 6, 2017.

At age 94 and 91, Norman and Mae have enjoyed what can be considered a long life and an even longer marriage. The article indicates that they have always lived together- no easy feat at any time. I sincerely doubt they ever anticipated having to live separately in order for them both to receive publicly funded care in a Long Term Care facility.

As we age we may not always have the same health care needs as our partners. A couple’s different care needs may be able to be met in the community if finances permit either at home or in a retirement setting. However when care needs exceed what can be met in the community, many look to Long Term Care facilities, our publicly funded ‘nursing’ homes.

Norman and Mae had both applied for Long Term Care. The process for those who may not be familiar requires an assessment and a finding of eligibility by the Community Care Access coordinator. Once deemed eligible, one can choose up to five residences. From here, the choices can be for a ward room rate, semi shared rate or a private room. Regardless of where one lives in the Province, the application process and associated fees are the same.
Accommodation costs are set by the Ministry of Health and Long-term Care and are standard across Ontario. The current rates (maximum) are:

Type of accommodation Daily rate Monthly rate
Long-stay Basic $58.35 $1,774.81
Long-stay Semi-private $70.35 (Basic plus a maximum of $12.00) $2,139.81
Long-stay Private $83.35 (Basic plus a maximum of $25.00) $2,535.23
Short-stay $37.77

The Ontario Long Term Care Association provides the following information based on 2015 data*:
• 627 homes are homes licensed and approved to operate in Ontario
• 57% of homes are privately owned, 24% are non-profit/charitable, 17% are municipal
• More than 40% of long-term care homes are small, with 96 or fewer beds
• Of these small homes, about 43% are located in rural communities that often have limited home care or retirement home option
• 76,982 long-stay beds are allocated to provide care, accommodation and services to frail seniors who require permanent placement
• 708 convalescent care beds are allocated to provide short-term care as a bridge between hospitalization and a patient’s home
• 362 beds are allocated to provide respite to families who need a break from caring 24/7 for their loved one
• Approximately 300 of the provinces long-term care homes are older and need to be redeveloped (more than 30,000 beds)
• The average time to placement in long-term care, as of December 2015, was 103 days
• The wait list for long-stay beds, as of December 2015, was 26,495

So what happened? According to the story, Mae was offered a bed at her preferred setting. By the way, one typically has 24-48 hours to make a decision as to whether to accept the placement or not. If she accepted the bed, Norman would be on his own, which the family felt was not manageable. She passed on the placement bed so she could remain with her husband. Only a few short weeks later, Norman was offered a spot at the same facility where Mae had declined the bed offer. However due to Ministry policy her name had been removed from all of the waiting lists and she now has to wait 3 months before she can even reapply. There was no mention how long the initial waiting period had been. Many of the ‘preferred’ homes have wait lists of several years.
Yes, there is a spousal reunification policy established by the MOHLTC and implemented by the CCAC, however we can only hope that Mae and Norman survive long enough to finish telling their story.

* Sources: Long-Term Care Utilization Report, December 2015, Ontario Ministry of Health and Long-Term Care; Ontario Long Term Care Association, internal database, 2015.

Bittersweet Holidays

by Audrey Miller on December 29, 2016

in Articles & Blogs by Audrey, Caregiving, Elder Care

Originally posted @allaboutestates.ca

In another few days we will say goodbye to 2016 and hello to 2017. This time of year for me, is a time of reflection. Most jarringly- is wondering where did the time go? While I try to be in the present, I am not always successful. What seems to be no slower than a blink of an eye, another year has passed and it is my older (and more wrinkled) face that greets me every morning. I am one of the lucky ones.

My last blog of the year is about recognizing those of us who have lost a loved one over this past year and a special ‘shout out’ to my mother who is grieving the loss of many of her close friends.
The holiday season, especially for those who have experienced the death of a close friend or relative, can be particularly difficult. Even more challenging is when the death date actually occurs on an already marked day, such as a birthday, Christmas Day, first night of Chanukah or New Year’s Eve, which is when my father died. As a result, for many of us the time can be bittersweet and the happiness of the holidays may be overshadowed by sorrow and sadness.

We have been told that time heals and I know it does. This short blog is a reminder to consider those around you who may not be celebrating.


2016 Holiday Jingle

by Audrey Miller on December 20, 2016

in Articles & Blogs by Audrey, Baby Boomers

Please enjoy as intended, with a wink and a smile 🙂


T’was the fight before Christmas, when all families know,
It’s better to forgive than tell them to F. O.,
Mom probably liked you better, if memory serves,
So while I am a P.O.A., she will get what she deserves.

Come on siblings and get off your butts,
I need alittle help, ‘cause I really am going nuts,
I am pulled in many directions, with no time for my own,
Let’s hire an expert who we can speak with by phone.

This Plan will save time and money; and help us agree,
We can all care for Mom, in addition to me!
A Plan of Care will outline Mom’s needs,
Working together, we all will succeed.

All families are strange, of this I am sure,
Now where did we put Elder Caring’s brochure?

Some guidance is needed to keep mom from harm
‘Cause with caregiver burnout, I’ve nearly bought the farm
I won’t wait this time, I will call them right now
Professional counsellors will give me know- how.

I found it along with various papers
Advanced directives, wills, now finally some answers!
From my heart to yours, I only want the best
Glad to choose Elder Caring over the rest!

Meeting a counsellor, has made it much easier
I now have perspective on how to proceed
Hiring a caregiver is just what I need!

Alittle respite will go a long way
Of keeping my sanity day after day.

Why did I wait? I really don’t know
We are living to 100 and there’s a long way to go
Having knowledge and resources makes it much easier
And learning when to say Yes and how to say NO!

Our government tells us, we should be aware
For those less fortunate, it may not be fair

Our society is aging and we all will need care

Live with your children? A threat or a dare?

Dementia is scary, forgetting all we know

The best is to love  but how can we let go?

I too am part of the boomers, still looking ahead

One needs to be positive, no point feeling dread

We’ve had the talk and filled out the  Binder

Make sure your wishes are clear- just a reminder

What’s ahead for us all, we really don’t know

I hope to have the choice when it’s my time to go….

Planning ahead – my message is clear

Keep talking to your family and loving them dear.

 Happy holidays to you all. Thanks for reading and from all of us, our very best for a healthy 2017.




Originally published @allaboutestates.ca

Holiday travel is around the corner.  Traveling with older parents does require pre-planning and this blog highlights my recent  trip  accompanying my mother to see her older brother and sister in law who live over 4,000 km away. Like any trip, it required organization but alittle more so to ensure we had:

A direct flight, a wheelchair available at both departure and arrival x 2, renting a large enough car, and most importantly I think, an adjustment in our expectations.

There have been some recent concerns regarding a lack of wheelchairs at the airport. If the senior was travelling on their own, they need to have a lot of extra time to wait.  We were able to commandeer one.  Travelers using or accompanying someone in a wheelchair does allow for a much speedier trip through security and immigration (tip one).  We also booked bulk head seats; while more expensive it was really appreciated, especially for an overnight flight (tip 2).

As mobility and stamina are common concerns for many, as they were for us as well,  we tried to keep to one outing per day.(tip 3).  Most activities started after lunch time; rushing to be somewhere first thing in the morning does not work out well (tip 4).

The hardest part of any trip and visiting with loved ones who live far away, especially when one’s health is failing, is saying goodbye.

I am glad to say that my mother and uncle are face time/skype savvy. While the departing hug has to last a long time, it is good to know that they can see each other again tomorrow and the next day and the next day – thanks to technology and their IPADs (tip 5).

A Place To Call Home

by Audrey Miller on December 1, 2016

in Articles & Blogs by Audrey, Dementia

Originally published @allaboutestates.ca

One Kenton Place is alive and well!

As readers may remember, I had previously blogged about One Kenton- as an innovative new community for individuals living with dementia.

To remind you, One Kenton was designed with state of the art dementia/age friendly collaboration with Ivey International Centre for Health Innovation at Western. It offers a  home like setting designed exclusively for those with dementia. It was funded by B’Nai Brith of Canada

One year or so after opening their doors, One Kenton was on the verge of bankruptcy.  At $7500 per month, they were unable to fill their 44 beds.

Fast forward to the present time. I am glad to say, One Kenton Place, with a new name and new management, is alive and well.  Families may still find it a challenge to meet the monthly financial requirements (starting at $6,975/monthly) however for those that can afford it, it provides a nurturing setting that works to truly appreciate the individuality of the resident.

The hope is that OneKentonPlace can serve as a model, a model of care that can be duplicated in other communities.  We need options and creative ways to continue to support our loved ones, especially those we are losing to dementia.

Sad to say, I view dementia as our biggest health challenge and it is not going away any time soon.


Turkey, Tradition and Dementia

by Audrey Miller on November 24, 2016

in Articles & Blogs by Audrey, Dementia

Originally published @allaboutestates.ca

Today is American Thanksgiving. Being north of the border we have already eaten turkey and hopefully have given thanks for all we have. However, many American families will be getting together to share a meal. Many will be driving or flying  so that they can  be with their families. Many of these adult children are also long distance caregivers to their aged parents or other relatives.  A recent article from Northwestern Mutual Life Insurance in their article Home Care: Closing the Gap for Long-Distance Caregivers   highlights that for Americans “seniors live an average of more than 280 miles from their nearest (adult) child. In many cases, the kids have moved away to pursue their own careers. In others, Mom and Dad made the move, often retiring to a warmer climate. Either way, distance is the new reality for many of today’s families.”

Dr. George Huba summarized the US Thanksgiving as “Thursday is the big day of excessive eating, excessive television viewing (especially of football), excessive consumption of alcohol, excessive noise, excessive bickering, excessive arguing, excessive chaos, and excessive assorted silliness.” He has provided some tips through a mind map to highlight supporting a family member with dementia through holiday and family dinners.



Large family gatherings can be difficult for those with dementia. Dr. Huba says “it just takes a little planning and a little tolerance for ‘changed’ behavior. And a lot of love.” Happy Thanksgiving to our American readers.