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)

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.